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d/''L Z-7 <br /> 'y Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 ; <br /> 0 <br /> ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> rvn herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County La d Use m C <br /> ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin — o- <br /> �. �... . .. ......c.4'�.. .............. . ..... ...... .............. . ........ .............................. ......... <br /> O EA (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> . ...... . . ..................................................................... ......... a <br /> . . . `...... �.o.�o.... c> m <br /> ............ <br /> ADD E55 // // ADDRESS I <br /> �.... . . . . ` f�6/T <br /> 7` ............. . .............................w.r.,................ .................................................................................. ......... '9 <br /> ADDRESS ADDRESS ;p <br /> ................................. ......................................................... .................................................................................. ......... —k) <br /> PHO PHONE t <br /> ..N' .R. ��' .J........................................... ............................................................................................ (y� <br /> PLUMBER WELL DRILLER El r <br /> O <br /> ....... ......... <br /> . . .................................................................................. .AD......DRESS.................................................................... . —. <br /> ADDRESS <br /> ........................................................................................... ............................................................................................ O' ,» ^ <br /> PHONE PHONE Z H l• <br /> r l� <br /> DESCRIPTION 4. Sanitary Facilities: ° <br /> 1, Work: No. Bathrooms <br /> 2. New Building Details """"" <br /> yy No. Bedrooms .... <br /> New Building �.- <br /> 9 a <br /> ....ly... Type of nstruction: <br /> Addition hG nn.—f•^' Septic Tank Size Gals, 7r....V <br /> Sanitary ... Size ..� :.1 ft. ft <br /> x ...�>...... . U1 � <br /> �.. tion Field Site:Absorption Filling/Grading .....,,... Height............. Stories ............... 4a. <br /> Moving .......... Area .................................... Soil Type ............................... ............... (�� 1 17- <br /> Mobile <br /> Mobile Home Slope ........................ o <br /> i <br /> .. <br /> Privy .......... 3. Use (describe exactly 1 -family Pere. Rate ........................ .......... <br /> Well ... .. home, garage, motel, et Dry Well ....... <br /> .. <br /> Subdivision .......... Seepage Trench <br /> .................................................... <br /> Camping Unit .......... <br /> Privy <br /> Seepage Bed .. ....... : <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc, should be sketched in Fig. A. Incur le roado. <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highw y 'inter- dj <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. _ O' <br /> --_—___—_—_---------------------------------------__—____._—--------_ _.\` <br /> 5. Lot Size: Fig. A. 6. Location: s � -> <br /> ................ ft. x .............. ft. . ............................... sq. ft. ................................................................... .. . . <br /> a <br /> do <br /> p i Q j. <br /> o <br /> ca <br /> x..� <br /> ~1� s SU r4 <br /> Z Z. <br /> id, elC� ° <br /> d <br /> 7Sr o <br /> ss, <br /> .1 �SXay <br /> v . Crr <br /> z oo' a 7C <br /> vt - <br /> .(� 0 <br /> 0 <br /> o <br /> yZ�'1�� ....... . ................ ... . . ... .. E�o <br /> S <br /> R <br /> Signa re of Owner or Agent a � C <br /> x rr <br /> Remarks L..'.-��. :�..�'-t`z. "-t— �t : C <br /> m : <br /> 60 <br /> ............................................................................................................................................................................... ........ — <br /> `. II <br /> .............................................................................................................. .... ....... Q). <br /> Inspection Date .. ....�(:..`.�.'.�.. 'N^ � o � u <br /> Zoning dministrator goo $ <br /> n approval ranted on all structures involving sanitary fa�uc <br /> NOTE: A preliminary site inspection must be made and site al f g g <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatio I test most be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any huild- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the Ir formation conveyed here- <br /> with is found to exist. Changes in plans or specifications that not be made without approval of he Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />