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l J 11 <br /> At County Office of Zoning Administrator I 0 0 <br /> APPLICATION FOR SANFTARY= LAND USE — BUILDING PERMIT 3. <br /> i <br /> THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as u, <br /> mown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lan Use m I <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisc nsi n. 3 o- <br /> O <br /> .. �... . . .� �. ..................... . ............................................,....................................�'i........ <br /> a <br /> OWNER (please print.... .... <br /> ) CONTRACTOR or SURVEYOR or AGENT a <br /> ......do..X. 1.1.94 - <br /> ............ .......................................................................................... <br /> ADDRESS ADDRESS m i <br /> 5va...o ...............1 .5.�................ . .................................................................................I......... <br /> ADDRE S ADDRESS <br /> Stf$O/............ . ......... <br /> ............. ........... ..... <br /> PHONE ......................................................................:. <br /> PLUMBER WELL DRILLER..............................._.........................i <br /> .................................................................................... O <br /> .. ...................................................................................... ADD. RESS <br /> . ... <br /> ADDRESS 0 o <br /> O <br /> .. ........................................................................................ . . .................................. ..... <br /> PHONE PHON.. E . ..������� <br /> DESCRIPTION 4. Sanitary Facilities: ° o " <br /> No. Bathrooms I..�..•. <br /> v <br /> 1. Work: 2. New Building Details �_ o i <br /> New Building .,........ Type f Constr c ion: LA <br /> No. Bedrooms ..a .... ;� <br /> Addition ,,, ,�� „�.,,� Septic Tank Size Gals. ..a"...... <br /> Sanitary .......... Size .... 6..�. ft. x ...1141 ft. L......... <br /> Filling/Grading .......... Aeeaht.....$.3..P��rI�. Soil ype..... �a...... �. <br /> .... m <br /> Height 4a. Absorption ie It <br /> Moving . . .. .........,. � o <br /> Mobile Home y <br /> Privy ,,.,,...., 3. Use (describe exactly 1 -family <br /> Parc. Rate ......l..a .......... <br /> Well home,garage, motel, etc. Dry Well 0 <br /> ..... Seepage Trench <br /> Subdivision .......... .....`.............................................. fir- <br /> n structures, well, sewage systems, roads,etc.,should be sketched in Fig A. Inclu T <br /> Privy <br /> Camping Unit <br /> .......... .......... ............................... ......... Seepage Bed <br /> -------------------- -- --- <br /> Location of proposed structures and existing g g �le road Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a hlghw�y inter- ( t a <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. o <br /> 5. Lot Size: Fig. A. 6. Location: .kSSk <br /> .atJ910..... ft. x *g6,.... ft. — ............................... s9.ft. ............ ......................................................f.......... <br /> . _ [ <br /> so <br /> P <br /> 3p <br /> 0 \\\ <br /> \ O <br /> ..�—. p <br /> 77J _ � <br /> t Z <br /> f� o <br /> x <br /> li <br /> Q : <br /> \ M on v . mzQ <br /> < <br /> m C d m NE. F <br /> �aC� <br /> < n <br /> N >2 It <br /> see fo('N Ibil j <br /> r <br /> O 0 <br /> ...9. .. .. . . . . ............ a.. /Date/ ..... ,.. a I i <br /> .. ....... .... <br /> Si na ure of Owner or Agent` Date X <br /> ...................................................................................................................................' T <br /> r <br /> Remarks ......................... t <br /> m <br /> .......................................................................................................... ...... ................... ........ <br /> ... ....... <br /> Inspection Date ....................................... .. .... ......ons'„ '.......... !......... 8 0 0 o S N i <br /> Zoning Ad Istrator <br /> NOTE: A preliminary site inspection must be mad nd 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 attacher) to <br /> this application before a permit will be issued. Do riot purchase or install a septic tank, do any plumbing or start any budd- <br /> ing until a permit has been Issued. A permit may be revoked if misrepresentation of any of the iInformation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm Inlstiatol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />