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Burnett County Office of Zoning Administrator b' k e <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3" <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby '� ^ �• <br /> g y makes application for Permit for the work requirements <br /> o and <br /> located as shown herein. The undersigned agrees that all work shall he done in accordance with the requirements of the c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> reg let ionsat the Stateof Wisconsin. 3 ' <br /> G,w� d...._.yUu:1rzer..................._.._....._....... ......... . . . . .. .. . . . . . .. . .. . n <br /> ... . . . . . .. . .... . . . . . . ........................................... <br /> NEER Please Print) CONTRACTOR or SURVEYOR or AGENTIf <br /> .. `.:�t..�:.�............................................. ........................................................................................... p d� ti <br /> ADDRESS ADDRESS <br /> ivy: S: e.,....4vr.........._S'(.�`,3............ . €� <br /> ........ ................................................................................... <br /> ADDRESS ADDRESS <br /> .......... ... ............................................................. <br /> PHONE <br /> , P..r�r <br /> .......... ......................... ... L .... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> �S _..t........W... ............................. .ADDRESS........................................................................... <br /> AOORE . � <br /> �U..........�............ .............. <br /> n c <br /> . <br /> . ...............:... <br /> PHONE PHONE Z <br /> DESCRIPTION STkJ <br /> P r <br /> 7DiGt17 . y <br /> o <br /> No. Bathrooms -P <br /> 1. Work: 2. New Building Details ..... o ' <br /> No.Bedrooms ......... ^ < <br /> New Building ,,,,,,,,,, Type of Construction: ! [fl 'r $ [ <br /> Aaaumn ,,, Septic Tank Size Gals. .. ... : [ <br /> Sambry Size .............. ft.x ft. .......... .0 tss <br /> .......... ..... ........ - 11 <br /> Flllinglcradling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Movie, .......... Area ......................................... Soil Type .................................... r <br /> 9 <br /> Mobile Home .......... $PPe .......... .. v :J ^ <br /> o <br /> Pit, 3. Use (describe exactly, Parc. Rate ... <br /> 9 -family <br /> Well ....... ho e,garage,motel,etc.) Dry Well J <br /> Subdivbion .......... + �' CM Seepage Trench <br /> ... .. (.:.1^..'. :...�.r..:....... ................. Privy L <br /> GmDing UnItS - <br /> .- ................._.._......-- ................. Seepage Bed ..:`:... - <br /> I <br /> N =11i <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fig. A. jljO c �rt <br /> Include road setback,sweated back yard dimension and location and setback from all bodiesof water. If property is located at 3 K `Is <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. _ `- <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS <br /> __--`______________________________________________________________ "O <br /> o >` <br /> 5. Lo[ Size: Fig. 6. Location: <br /> t. U1 <br /> / o !zi <br /> 5z-7e, -'JLC11/y"d <br /> � . . <br /> of <br /> EXHIBIT //`'�^"� Z <br /> a <br /> ap <br /> n m � mdnmm � <br /> Ua< _ om vaa <br /> o o -m ; <br /> Z»6 . � > —1 <br /> Signature of Ow er or Agent0 <br /> e a <br /> Dt '--- Y� $ ° <br /> ..............................................t� r <br /> Remarks .... .. .........._..........................................._......................_......_................._ ri <br /> ...................... ..............f.............................................................................................'�I.I.D......................................... o : o <br /> ........ _ X ............................_._....._.. .........../�....Z .ing Atls�rator%)z) 8 8 8 U <br /> w <br /> ............................/.... ......-........................ 8 <br /> .................... m <br /> Inspection DategC..................................... U <br /> NOTE: A preliminary site Inspection must be made and site approval granted on all structures involving sanitary facilities before construct ton <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation lest must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be/ <br /> revoked it misrepresentation of any of the information Conveyed herewith i5 found to exist. Changes in plans or specifications shall not be/ <br /> without approval of the Zoning Administrator. f. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />