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IBurnett County Office of Zoning Administrator(Ji f h. n .I 0 o <br /> _APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT G 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described aro roamed as <br /> shown here, The undersigned agrees that oil work shall be done in accrued rice with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code,and with all other aopllidable County Ordinances anal the laws and regulations of the State of Wisconsin. 2 <br /> ..f/1..L.C.h4.�C._......'-^.(_5(.'R^...2.2.[.../Y..(h........... _........_.....x_7.. '... ........._..........................._......._ d 'f 1 O <br /> I OWNER please print) U CONTRACTOR or SURVEYOR or AGENT nto <br /> F. . . ..............................................................................1 .Q.r..........R..r....L-...... ........................... ............ . . se <br /> ADDRESS ADDRESS i <br /> ADDRESS................................._....._...._._....._._................ .ADDRESS............_........................................._................... �'� i� <br /> ?HOW........:....................................................................... .PHONE................................................................................ <br /> �1 /f T r <br /> .... ,{' f I'.EH...r..........._............... ... - ............................_._._........._.........._...._... .0 :� p :� <br /> PLUMBER WELL DRILLER <br /> ..................................................._................... it'll i i <br /> ADDRESS ADDRESS .� .°. G: QV <br /> o V\1 <br /> ........................................................................................... ..................................... ...................................................... <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: / P 8 <br /> 1. Work: No. Bathrooms U 1 <br /> 2. New Building Details <br /> New Building ...X„ Type of Construction: No. Bedrooms .......... ;9J <br /> _. .... Septic Tank Size Gals.AdditmpF 'oyr C " v J 'er <br /> Site .ry. -- <br /> Sanitary .3 ... i[. <br /> uy <br /> J <br /> Filling ......._. Height...._._... Stories 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................. ...... .� o <br /> Grading .......... Slope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, -famll <br /> Pere. Rate ...................._............' <br /> Privy, ........- home,garage, motel,etc.) Dry Well .......... Y <br /> Seepage Trench <br /> Subdivision <br /> Well ...k:... <br /> .......... <br /> ..................._............................... Privy <br /> -` <br /> ....... <br /> Seepage Bed a.-- r)J F' <br /> _ Y U <br /> so <br /> I.ocatiou of proposed stracanes and existing suh,hr S,well,sewage systems, reads,etc.,should be eke¢bnd in Fig, A. Include road r .�J i r <br /> setback, side and back yard dimension and location and setback from all bodies of wool. If property is located at a highway inter. <br /> section, show the:imervmting highways and the setbacks repaired alcmg from and ar the imereaction. CLEARLY LABEL EXISTING I �: <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. .orIs <br /> --------------------------- ---------------------—————————— ° VIiZ` <br /> 5. Lot Size: Fig, A. 6. Local I a <br /> an <br /> zi <br /> l <br /> 0 <br /> a zi <br /> TN a <br /> z. I <br /> � p <br /> to <br /> �i <br /> A ad <br /> n tree f <br /> do-, <br /> o _ _ <br /> rn' - <br /> � t/ <br /> Sl.. ...... . .................................... ........... .....�. .a.......... - <br /> lb- no <br /> Signatureof0 � er'or Agent "'- �-�-- - -� ---Date"'' <br /> Remarks ..(.! x <br /> .�L1,..rFin_� ZIe-�L�'j......._............................................_._.......:....................................................... T <br /> be <br /> ...................... ..............._......._...................... ._........_... <br /> Inspection Date ?. �....>2.5" .� Qtr/ 0 0 0¢o Inn <br /> pp e: <br /> Zoning Administratordo <br /> i 000 0.V <br /> NOTE'. A or or nr inary site inspectinn must be made and si le approval star full on all sit tic lures involving sant lacy far.i li t rh <br /> before construction can begin. In theca se of se overage disposal systems, a copy of the pe rco)'Bari Inst in be ;;trached tous <br /> this application before a permit will be issued. Do not purchase or install u septic tank, do eny plumhing or ,sort any budd- <br /> ng until is permit has been issued. A permit maY be revoked it misrepnaentation of Illy of the inlotmalion conveyed her - <br /> with is found to exist. Changes in plans or specifications shall nos be ""'ho without approval of rhe Zoning Albn inistra aur. I <br /> SEINER SYSTEM SHALL NOT RE COVERED UNTIL INSPECTED RV THIS OFFICE AND APPHOVED. ! <br />