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U'/ t � K,�, <br /> Burnett County Office of Zoning Administrator u -f 1/z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m ;� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> /regulations of the State of Wisconsin. <br /> ... <br /> 0 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m .~ <br /> 35..oc,Q2. <br /> ADDRESSJ.t�................................. .... ..... <br /> . <br /> ................................................................................. m :O <br /> / ADDRESS :S <br /> s !rC.... .....sS..��.3.................... . . . ..................................................................................... ' <br /> ADDRESS <br /> ADDRESS <br /> PHOIy?� % n PHONE <br /> PLUMBER . .......................................................................................... ' :1 <br /> WELL DRILLER 'Z <br /> Jar <br /> . . . . ..... ................................................................................. <br /> ADDRESS AD.. DR..ESS i(-t� � M <br /> . <br /> n o <br /> rC <br /> tai <br /> ........................................ . .......................................................................................... - <br /> PHONE PNONE <br /> DESCRIPTION a o <br /> 4. Sanitary Facilities: � o <br /> t. Work: 2. New Building Details No. Bathrooms i <br /> New Building No. Bedrooms 'O o <br /> g X Type of Co struction: ��+�••• '� � E <br /> Addition ... .. ... Septic Tank Size Gals. .......... U ;, <br /> Sanitary .. ... Size ....2,6 ft. x ..�.�. ft. ••••••• : `� <br /> Filling/Grading ,,.,,,,,,, Height../..7.:4.. Stories ....(.......... 4a. Absorption Field Site: <br /> Moving .......... Area ......a'34..Sep Soil Type .................................... <br /> Mobile Home Slope .......................................... 0 o <br /> \. <br /> PrivyJU�.,........ 3. describe exactly, 1 family, Perc. Rate ................................... <br /> Well home Dry Well .......... 1 <br /> ..X.... garage, motel, etc.) <br /> Subdivision ........ page Trench .......... <br /> .................................................... <br /> Camping Unit .......... Privy .......... r' <br /> .................................................... <br /> _________ Seepage Bed .......... <br /> Yom,. <br /> __________ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road I � <br /> setback, side and back yard dimension and location and setback from all bodies of water. If - <br /> property is located at a highway inter <br /> section, show the intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING <K vl <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. N. < <br /> _._.______________________ ______________ —__ 0 <br /> O <br /> 5. Lot Size: Fig. A. 6. Location: t •' ''�, <br /> ....srZ. W.. ft. x ...6.0..0. ft. . .....�20 6W...... sq. ft. ............................................................................... <br /> n <br /> U � n <br /> Cf o <br /> oON <br /> oi <br /> A _ <br /> IJOS C o <br /> Q <br /> /77 V <br /> 7J Vlr v W <br /> m ka <br /> Na <br /> <' <br /> � m = m <br /> y��ww Rt o a <br /> R 3 <br /> ................. ....4.- 2 7—�Q-- p <br /> na re of Owner or Agent Date <br /> o C <br /> G� �� . GOz`E7 X <br /> arks ................... T M <br /> Zc Ge <br /> ........../ ut�z...� <br /> / -7 ..... .. .. ...................................... . .............. .�//. ...................................... <br /> Inspection Date 10...J.' ./ .......... i. .. .. ...:.... .................................... +e: u a o u o' a m <br /> !/ +O <br /> Zoning A inistrator $ $ $ $ $ $ cmn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction Can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will he issued. Do not purchase or Install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />