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0 -7`1 t- ^�7`7' <br /> Burnett County Office of Zoning Administrator d --i 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT � 3 � <br /> d <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as '� w <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 regulations of the State of Wisconsin. 3 ecrms <br /> t <br /> O <br /> ahn......6.: M <br /> OWNER <br /> (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> k. s...l!�. ?.. ..5..✓ .. : ......L^) ............................................................................................ <br /> A� 5J5 <br /> M MS.s = fi <br /> (E�/ .....�(.��........... <br /> ....... <br /> MA) ADDRESS <br /> ..... ...(... ' 7..... ............................................................................. � <br /> ADDRESS ADDRESS <br /> G.1..z.. ".. 5S%........ .S`'� <br /> ............. <br /> ... .......................... ............................................................................... <br /> PHONE PHONE <br /> ........... ............................................................................... . . . ................................................... ........... :Ri C� <br /> �l <br /> PLUMBER WELL DRILLER /�� � :J $� <br /> ........................................................................................... ..................................................... ...................................... O <br /> ADDRESS ADDRESS <br /> ............ <br /> .. ........................................................................................ <br /> ................................................... ........................... <br /> PHONE PHONE z � � <br /> DESCRIPTION 4. SanitaryFacilities: ° ° o <br /> 1. Work: 2. New Building Details No. Bathrooms a <br /> o ,L <br /> New Building Type of Cstruction: No. Bedrooms 3..... ne z <br /> o� m t <br /> Addition ,,, ,,,,LDS...................._...,. Septic Tank Size Gals. ....1a...... <br /> o � <br /> Sanitary .. Size ..... ..2. ft. x v. t <br /> Filling4a. Absorption Field Site: <br /> Height............. Stories ..c�.. • ; .\ <br /> Moving .......... Area ....... Soil Type ..........`.S.a.n..d........... +, U r <br /> .................................... <br /> Grading .......... Slope ........................ .... kt .4 <br /> ir <br /> Mobile Home Perc. Rate .......u.h. .x h...: .... <br /> .......... 3. Use (describe exact 1 -family <br /> Privy .....,,... home,garage, motel, etc. Dry Well .......... 7 <br /> Well ✓ Seepage Trench <br /> Subdivision .......... .................................................... Privy .. '`C. <br /> .......... .........._........................................ Seepage Bed <br /> --------------------- -___—_--------_ ____ .N <br /> Location of proposed structures and exlsting structures, well,sewage systoms, roads,etc., should be, sketched In Fig_ A- Include road <br /> setback, side and back yard dimension and location and setback horn all bodies of ureter. It property is located at a highway inter a <br /> section, show the 'mtersectin9 highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PHOPOSED STRUCTURES AND ADDITIONS_ <br /> 0 <br /> 5. Lot Size: 6 /kR Fig. A. 6. Lo atiQ,n: re� U <br /> _.... ......... ft. x .............. f'f. — ............................... s4.ft. .....10l .5..4.N................................................. <br /> o � <br /> / <br /> 3 N <br /> O [ [v1 <br /> T <br /> � 3y , <br /> s <br /> n; <br /> Z :C3 <br /> (1 <br /> L o T <br /> T �S �-1 <br /> apo <br /> DO to t- <br /> 3 3naoa< - - <br /> �as o 05 € <br /> » 3 3 <br /> F ��..u`ti ...... .....D� ./... .. .. .. v1 p <br /> 0 <br /> /J a <br /> Xign� of Owner or Agent <br /> 7N /•� X i i 31 <br /> Remarks .6..!.1..XrC...' ..Z..-c.._................................................................. ............................ 0 <br /> ....................� 4 .. (%ti�..�... �:Gi..... fly C �a...Q �...... :�^ � .......................... <br /> o: <br /> //................................................................................. . .............. .................................... <br /> Inspection Date .yT., ....,../ o 0 0 0 6 ITI <br /> M... .......T........... .... ............ ........... . ...................... :1 00000 <br /> v;� Zon.l.n9.A..ministrator o o o o o In <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 /> - <br /> until a permit has been issued. A permit may be revoked if on lsr epresen tat ion of any of the information conveyed here- <br /> - <br /> found to exist. Changes in plans of specifications shall not be made Without approval of the Zoning Administrator . <br /> -R SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />