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nett County ' Y Office of Zoning Administrator 0 0 <br /> r APP!_ICATION FOR•.SANITARY — LAND USE — BUILDING PERMIT 3 I <br /> //TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as ZT c^ <br /> showA herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 c <br /> � n.., ./.E �N <br /> COMPUTER <br /> o/l f.,C' 1 j ...................... _ o <br /> ... ................................ . . . . � ... <br /> OWNER lease print) CON TOR or SUR EYOR or AGENT - a <br /> Q.,tl......a�o �................................................ cis ............................................�.......... <br /> d _ <br /> . . ...... . : <br /> ADD ,SSS p ADDRESS <br /> ADDRESS ADDRESS ' <br /> ........................................................................................... ...........,21,, ... ..........`i�..... ................. <br /> PHONE PHONE <br /> �.l�. y....a`X53... ................................ ........................................ � <br /> PLUMBER /{ ( WELL DRILLER h <br /> . . ,^o, .. / .. .................................... .................... <br /> ......../.' <br /> iii•^'...` .......................... <br /> ADORES ADDRESS <br /> o <br /> ...... /h'j'��'.......,�,-8.f—zo �........................................................................................... :`C o <br /> PHONE PHONE Z '� r :\ <br /> DESCRIPTION 4. Sanitary Facilities: �qq ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms QS.. k o <br /> New Building .......... Type o Co s �c Me: No. Bedrooms ... :� o <br /> Addition f,(j ......... „ Septic Tank Size Gals.. ......... <br /> .. .. ... o� <br /> Sanitary „7 ., Size ..� ft. x .�0p... ft. 4a. Absorption Field Site: <br /> Filling •••••..... Height...�Z/... Stories ........... <br /> Moving .......... Area ........................................... Soil Type ....................... . ....... r6:7E <br /> o <br /> Grading Slope .......................................... 0 <br /> .......... <br /> Mobile Home 3. Use (describe exactly 1 - mily Perc. Rate ............................ ...... <br /> .......... . . <br /> Privy home,garage,motel,a Dry Well .......... <br /> Well Seepage Trench .......... <br /> ................................................... <br /> Subdivision ,,,,,,,,,, Privy .......... <br /> .................................................... Seepage Bed pct <br /> ---------------------------------------------------------------------- rn <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- T. °_- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. G H <br /> o' <br /> ------------------------------------- --------- -------- W 3 <br /> KA <br /> 5. Lot Size: Fig. A. 6. Location: O <br /> ................ ft.x .............. ft. — ............................... sq.ft. ............................................................................... <br /> d i <br /> 0 <br /> N O' <br /> O 7 <br /> t <br /> N <br /> \n\ T <br /> Z \-vv <br /> o <br /> d <br /> 7 <br /> M <br /> J <br /> M rnr-ernz <br /> 0i <br /> N <br /> m. NQa<o < g m <br /> mi m <br /> a 8 <br /> vsw� <br /> EF C <br /> Sig ure of Owner or Agent Date <br /> X <br /> Remarks (` n 0 <br /> CD <br /> ..................................................................................................................................................................................... . <br /> Op !' <br /> r (p <br /> T <br /> Inspection Date ....................................... . .......................... <br /> . ..... : . ............................. E i 000000m <br /> ZoningAd Istrator o 0 0 0 0 o Vs <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 be issued. Do not 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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />