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Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as '1 — o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a •tFJK <br /> .wo........All.......la �.9r:.t... ......... s 5 L7`�.`F.. �r7`���r. of �� N ° <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a m <br /> G.3.' ..... K��........�/q.r. � ....PF.......1. r . . �j n <br /> ADDRESS............ ...... .l...Y...../........................... <br /> ADDRESS ;U <br /> z <br /> ' .Cp lh....ton.......�e..4.c/7.....FL.. .....� cz..G.h..�:.Y............... <br /> ADDRE S 33�I�S ADDRF ....... G' :� <br /> 30 '-,........7, .....0.1.7.7................... si a?' <br /> PHONE PHONE <br /> ........!..1.......... ... ............................................................ ............................................................................................ W� O. <br /> PLUMBER WELL DRILLER c <br /> ADDRE55 .ADD..RESS.... .................................................................................... o <br /> M G <br /> < Le <br /> PHONE <br /> Z 17 <br /> DESCRIPTION <br /> 4. SanitaryFacilities: � o <br /> 1. Work: <br /> 2. New Building Details No. Bathrooms <br /> New Building No. Bedrooms ... .. :� -Oo <br /> ....X.. Type of Construction: <br /> Addition � lSeptic Tank Size Gals. ....... ::A <br /> Sanitary ... FftG <br /> 3< Size <br /> Filling/Grading ....... Height............. Stories .... ....... 4a. Absorption Field Site: i <br /> Moving .......... Area ............ . . . . .. Soil Type .................................... <br /> Mobile Home ........ . Slope .......................................... 0 <br /> ,.. . <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well homef,garage, motel, etc.) Dry Well .......... <br /> Subdivision ........ . /qr,. V/v Seepage Trench .......... <br /> z` ............. Q� <br /> Camping UnitPrivy <br /> ......... .......... :( <br /> .................. . ..f/�'/(.�............... <br /> Seepage Bed ....1..... OQ <br /> ---- ------------- — -- --- <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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. H <br /> 0 <br /> ---__-------------_.---------_--------_— _—_--------------------- ,.Z i <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> _qq <br /> 4 <br /> 0 <br /> S <br /> t � <br /> apo <br /> cnr v � m n so <br /> rp, N d •i w ¢ W <br /> on <br /> Z O p a D a m <br /> 3� 0 <br /> m <br /> G+ :.. . .... . .... .. . . .......... .. ...a�.....r�� o C) <br /> Signature of Owner or Ag nmt Date <br /> Rem /�•/t. ZIarks .. 6t x <br /> � / <br /> p <br /> .............................. .. .......2./f 1 .........�'I..rt..... ................................................................................................. - <br /> ..........................................................I................... <br /> _ ................ ....... . <br /> Inspection Date ... -:�.7................ ... Z ........:.....`.....'. ,. ............ o $ $ T <br /> Zoning <br /> NOTE. A preliminary site inspection must be made and site approval ranted on all structures involvin sale atfa.r it <br /> 9 9 Y <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 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 be made without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />