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fr7'C�^rte . <br /> Burnett County Office of Zoning Administratord o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 <br /> �j <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 Y.J <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis opsin. a <br /> Q.:T..T.....C. ...Tt.Ns. r!�. no <br /> .................... .PEO. .ES....Co.nkti,.. ..1�I.s.N.1ly...LU '..7... �j <br /> OWNER (� l(e�e print) T \ / CONTRACTOR or SURVEYOR or AGENT m _ m <br /> .. .�..`.f....l.... r..-11,..k/............................................ . ........ ....................................................................... ......... <br /> ADDRESS I rnI{/VI' ADDRESS 1 ,d, pG0 <br /> ADDRESS ADDRESS 'y <br /> .eta..... .. i.... .. ..................................... . .. .....a.s.9.- . .ss. .. . .... ... <br /> PHONE PHONE <br /> Z <br /> PLUMBER 'W"E"L'L <br /> ..........LLER................................................................. ......... <br /> ..... . . . ............................................................................... WELL DRIAA <br /> O <br /> "1 <br /> ADDRESS ADDRESS <br /> M 0 <br /> < N <br /> PHONEPHON.E...................................................................... ......... o <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 9r. iC <br /> 1. Work: No. Bathrooms70 <br /> 2. New Building Details . ... 7 <br /> New Building Type of Construction: No. Bedrooms ......... a % !� <br /> I <br /> Addition ...X... Septic Tank Size Gals. ......... <br /> . . ... . ........... .. . r�y{ . ...... .. <br /> Sanitary . ........ Size ... ....... ft. X ..aC�... ft. ......... <br /> FillinglGrading ...,,,,,,, Height..../{{.,�..//.. tQ9ries ............... 4a. Absorption Field Site: <br /> Moving .......... Area .....4Lf2�IlUyl. .......... Soil Type .......................... ......... r <br /> Mobile Home ......I... $lope ................................ ......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate .........................1......... <br /> Well .......... home,garage, motel, etc.) Dry Well 1 <br /> SubtlivisionMt 1_ !n� Seepage Trench —�- <br /> Camping Unit <br /> ��.,� -r—' ... Privy <br /> ......... V" <br /> ........ <br /> _____ Seepage Bed ......... <br /> ______________________________________________________--__— ___ <br /> Location of � N <br /> proposed structures and existing structures, well,sewage systems, roads, etc_,should be sketched In Fig <br /> A. Includ road <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property is located at a highwa Inter- 0- <br /> section, show the intersecting highways and the setbacks required along them and at the 'intersection. CLEARLY LABEL EXISTING U7 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 1 <br /> o <br /> =J <br /> 5. Lot Size: <br /> Fig. A. 6. Location: CA i <br /> ft. x .............. ft. — ............................... sq. ft. ..................................................................... ......... Cl <br /> L AKS 1Ce <br /> N <br /> a <br /> o <br /> _ <br /> _ <br /> h <br /> 2 <br /> �errntt- -1 D 7b ; <br /> I <br /> M <br /> fly, s m v m z <br /> aa � of <br /> on m S m <br /> < m <br /> y a m <br /> io <br /> .�. �f.......... <br /> M <br /> Signature of net orgent <br /> rt i �6ate/ �0 m <br /> OC <br /> Re.ma.!r�k:Ss.E...L..•�.."..�...N....T..............U'...r.t.✓....P....F......k..............�.....3C..!.5.7. <br /> !NC1... �x <br /> .......... ............................................................................... - m. .. ....... <br /> T ./.. W ......................................... . ...................... .....y....�................................. <br /> Inspection Date ................. , ,,, , /, , 7511 i "' a o N o m <br /> ...................... .... .... . .... .. . to <br /> m <br /> Zoning Adminis r for J„ ' E 8 $ o o o Vr <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary fdcllow, <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation est must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any pluirl 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 be made without approval of the Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />