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Burnett County Office of Zoning Administra or �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 6 3, <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described nd '2 M <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the �$ <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulations of the State of Wisconsin, ti n <br /> r — m <br /> r <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT ., <br /> .5.1/2F......h).T�.....� ............./.�.qx..on. ....r ..................................................................................... ...... a <br /> ADDRESS p ADDRESS �' <br /> ............w.S............................. ..................................................................................... ...... F ;i1J 1 <br /> ADD E ADDRESS <br /> 26-....-.... ............................................ ..................................................................................... ...... <br /> PHONE ............................................................................... PHONE ..... t <br /> PLUMBER WELL DRILLER <br /> L <br /> ADDRESS ADDRESS m � <br /> � O <br /> ........................................................................................... <br /> PHONE PHONE Z H <br /> DESCRIPTION 4. Sanitary Faci 'ties: ° o ° <br /> 1. Work: No. Bathroom v <br /> 2. New Building Details ••• •••••• 'o <br /> New Building Type,pfr Cnoat�etion: Sep Bedrooms ... ...... <br /> Addition ,.�„ ,,,,-„��I�/6-C,�..,,.. SepNo.tic Tank S't' <br /> Gal . ... <br /> Sanitary Size ....R4 ft. x . '. ... ft. ... <br /> ... ... <br /> Filling/Grading .......... Height ..... ....... 4a. Absorption Fiel Ite: <br /> Moving .......... Area ........................................... Soil Type ..... .... ................. ...... r <br /> Mobile Home Slope .. O <br /> .......... <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. R e ............ ............... ...... i <br /> Well .......... home,garage, motel,etc.) Dry ell ... ...... a i <br /> .......5 RA6� page Trench Z <br /> Subdivision <br /> .......... t3..P..�J.T. 7!9................ o <br /> Camping Unit ,,,,,,,,,, Privy ... ...... <br /> .................................................... Seepage Bed <br /> ------------------------------------------------------------- — ur <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. ` <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is locat of at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. _ oR <br /> -- — -- — — — — <br /> — --------------- --- --- -------- — --- ------ —— — <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ....................................................................... ....... • <br /> N O <br /> O <br /> 0 (1 <br /> 7 <br /> O <br /> Sipe 41bbcheC (aCj1 r)0V--1N <br /> T <br /> Z <br /> .0 <br /> m <br /> C'-ei) teal <br /> A-ny 00-4-crwn KO �R add; E�o� . <br /> e /]'n/ i <br /> �I "" oma < > > o m <br /> m �n�c � nm an y <br /> a o< <br /> 72 '0 <br /> O nN `� O f0 b <br /> 0- 1 <br /> orn� Nn <br /> a 2o : D <br /> = c_ <br /> 7.... l n : <br /> Si tur Owner or A ent Date <br /> M <br /> g <br /> Remarksm . . . . <br /> .................................................................................................................................................................... .... m a <br /> N <br /> ....................................................................................................... ..... ...................... .. <br /> .. ..... ............. .... . <br /> n' $ 8 T <br /> Inspection Date ....................................... ' o m <br /> Zoning Administrato 8 88 Us <br /> NOTE: A preliminary site inspection must be made and site appr val granted on all structures involving sanitary far ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation 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 beer issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or pecifications shall not be <br /> made without approval of the Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APF ROVED. <br />