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P <br /> Burnett County Office of Zoning Administrator Iu to -- o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 - <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H Q <br /> shown herein, The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use - ' <br /> Cow SanitaT Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin_ 3 ma j\ i <br /> ... ....�.L.................. ...PP... ........ ...... . .......................................................................................... ��\ o <br /> XER (please pri CONTRACTOR or SURVEYOR or AGENT m <br /> a <br /> . ... 14 <br /> �f...T. . . .. ............................. . ..................................................................................I....... <br /> A DRES ADDRESS <br /> 21 i C7 <br /> T. G( ...�//W„... .5....5...(..46........... ............................................................... <br /> ADDRESS L� ADDRESS <br /> PHI..a .. ../... ...L.C/..J..�....................... .PHONE.... . ................................................................................. 00 <br /> y� <br /> t� UO/l/... ......... <br /> PLUMBER......... ... .. .WELL URILLE.R................................................................... <br /> v” .rr ..�I�.... ...lPu�...t .....G................. ............................................................................................ o <br /> ADDRESSiv,ii ,���•Ul�• S"�/p'9'� ADDRESS <br /> G,J /` 7O 0 o <br /> . ................................................................................ <br /> 1=110NE <br /> �. .. . 6. . Y6Ss.. . <br /> Z <br /> DESCRIPTION o <br /> 4. Sanitary Facilities: , o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> New Building Type of Con tru 1�^ No. Bedrooms .. <br /> Addition ... �(J / ,••• • Septic Tank Size Gals. .-7 •G \ <br /> Sanitary .. ... Size ....a..7�.. ft. x <br /> Filling/Grading ,.,.,,,,,, Height........... Stories ....1........... 4a. Absorption Field Site: <br /> Moving .......... Area ......... Soil Type ...f .Q�..7�..FT � m <br /> ................................ . <br /> Mobile Home Slope o <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Fare. Rate ......... ...................... <br /> Well .......... home, garage, motel, tc.) Dry Well .......... �I <br /> Subdivision Seepage Trench ' ......'.. jC <br /> Camping Unit ,,, <br /> .......... Privy <br /> /8 xay..... w <br /> ---- ---------- ------------ Seepage Bed - , . d.R..— UJ <br /> led <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_ CLFARLY LABEL EXISTING = <br /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. — <br /> ---------------------------------------------------------------------- M <br /> (� <br /> 5. Lo //1�e: Z pl� Fig. A. 6. Location: o <br /> ... lip.. ft. x .. lO.... ft. — ............................... sq. ft. ............................................................................... <br /> SFE �47TACt-I ECJ PlfFtiS o <br /> rh <br /> l <br /> z <br /> 0 <br /> �cc f <br /> cr y m <br /> � VI G C : c � <br /> O O � <br /> O <br /> m <br /> y- <br /> � m <br /> Signature of 40wncpcorAge�nt� � Dat <br /> : m <br /> Remarks ......................................................................................................................................................................... <br /> .............................................................................................................................................................................I.......... el, -- <br /> ............................................................................................................ <br /> ..... ........................ .. .......... <br /> ......................... <br /> Inspection Date ....................................... G"_ ra o u, o u, <br /> H m <br /> ................ NN � � Nm <br /> Zoning Admirl ator �: 8 0 0 0 0 0 V7 <br /> NOTE: A preliminary site inspection must be made aud site approval granter) on all Structures involving sanitary facllltios <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 of specifications shall not be made Without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />