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e1't,)C("2/1 s. <br /> Burnett County Office of Zoning Administrator d b o <br /> '- <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 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 c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a r <br /> r: a <br /> <...................... <br /> DWNE (please print) CONTRACTOR or SURVEYOR or AGENT m i <br /> ... ..... X...a .g...................... a <br /> .............. .. ............................................................................................ a <br /> ADDRESS <br /> ADDRESS Q ! N <br /> ADDRES / .. 7/ / ............. .ADDRESS............................................................................ t <br /> PHONE . .......................................................................................... .� <br /> PHONE <br /> ........................................................................................... �wlw <br /> PLUMRER ............................................................................................ O <br /> WELL DRILLER .� <br /> ........................................................................................... 1 <br /> ADDRESS . .......................................................................................... : <br /> ADDRESS n G1 <br /> ........................................................................................... <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: r <br /> r <br /> —+ n <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> o <br /> New BuildingNo. Bedrooms .... a <br /> .. .. ... Type of Construction: <br /> Addition ,,,.,...., /riQrt/L7,.,$///[T,4? ..,,.......••• Septic Tank Size Gals. .......... -- <br /> Sanitary .......... Size .../A.... ft. x .oZ!J..... ft. ••..•..... �� <br /> EillinglGrading .......... Height,. '/$Stories ..../........ 4a. Absorption Field Site: <br /> Moving .......... rea .....31 .. ..... ..... ... Soil Type .................................... <br /> ,,,,���`f ff1j G . <br /> Mobile Home . ........ �`.'^"`�'i L•66�u.71 /i?X�d�� Slope ..................................... .... ° <br /> Privy Perc. Rate ................................... <br /> .......... 3. Use (describe exac y, 1 family to <br /> Well .......... home,garage, motel, etc.) Dry Well ......... <br /> Subdivision ,.,., ,.,. G Seepage Trench <br /> h!u cN......... tf9... I<... <br /> Camping Unit .......... Privy .......... til p � <br /> ---------------------------------- Seepage Bed .......... <br /> pe <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 04 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. n ` :� ulo <br /> --------------------------------------------------------------------- Y✓ /n <br /> 5. Lot Size: Fig. A. 6. Location: f <br /> 3r2... ft. x ...o&0. ft. - 5 i1GP� � <br /> . ................. sq. ft. .............................................................................. <br /> J <br /> K- <br /> � � o o. <br /> 47 JL/ o <br /> 47 go YJwm <zoo� o �[ �/Iky ° °U t� � <br /> ... ....... , . .� ��..... ....0.4.6�........... o <br /> gnature of Own <br /> rr or A en t Date /��,- ��// /'',,D/ — <br /> Remarks ...../.fir, tL ��F�Z 1Z....'� 'r '�.. FI..... .�^...'�'........ ..'�'"�'I.�f/L....� X � m <br /> .... . . .............................................................................................................................. <br /> . .................................................. <br /> Inspection Date �r/.,... '. ......................................... U o m <br /> Zonin dministrator ? 8 8 8 8 8 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facllIt, s <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must he attached to <br /> this application before a permit will be issued. Do riot 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 Ife made without approval of the Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />