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Ile 7,y J. <br /> Burnett County Office of Zoning Administrator P - 0 10 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as •< ,n :CA <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use to O <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> 0 <br /> .P...2.^),I ...........EME.� . .1� ............................... �1 <br /> OWNER (please pri t) CONTRACTOR or SURVEYOR or AGENT a <br /> s�4.1........ �l.N..ja..n?...... .1�. S..c ........................................................................I................... a <br /> ADDRESS ADDRESS ;N ;0 <br /> .n!V..L,s........M. .N,......s...s4(.9............................... <br /> ............................................................................................ <br /> ApDRESS ADDRESS <br /> (C?.!Z.. ..... � -90 ................................... <br /> A( <br /> ONE PHONE ^� <br /> .......... <br /> ........................................................................................... ..W..EL.....L...DR... ....ER.................. <br /> ....... <br /> ...................... <br /> .............. <br /> PLUMBER IL.. L <br /> ADDRESS ADDRESS 0 0 y� <br /> „ < <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ��•� <br /> New Building <br /> 2 v <br /> '•".....• �•� •• c <br /> Type of Construction: No. Bedrooms .... <br /> :3... <br /> Addition .. ,:, AR.D1rA.N.,..I3Nih^.k:!�.T'-.�RRAG6 Septic Tank Size Gals. .......... <br /> Sanitary ,;,,' Size ..,fir.. r... ft. x ...4:0.... ft. ••..... <br /> FlUinaLl3vading , „ Height�.= Stories .I...t:��t�/AUc 4a. Absorption Field Site: i <br /> Moving .... Area Jill <br /> '� fa.XA4...UP....... Of/T Soil Type .................................... <br /> Mobile Home . Slope .......................................... <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Dry Well <br /> Well ,M- home,garage, motel, etc.) ""...•.. <br /> Subdivision .......... <br /> Seepage Trench .......... <br /> ....I=...Fit.M.I.f.... .Y.................... <br /> Camping Unit Privy .......... <br /> .......... .................................................... <br /> Seepage Bed ......— ' . <br /> CA <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road L/' & <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 'b 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. ---------------------- --- <br /> ------- :\\'' 0 <br /> �y = :� <br /> 5. Lot Size Fig. A. 6 Locatigin y# i <br /> .7'.Q..... ft. x SSO... ft. ✓Z�j f7f)D....... sq. t. LDO/Y l�QkE• LBB LAkr...F/ ...�/r�0 <br /> 7 oR TAck SoN T'WNSP. ` <br /> 51=� SlR%PFl E sKE-`rc1+ o j. <br /> fi <br /> o � <br /> fV o <br /> s <br /> yj <br /> l <br /> Z <br /> 0 <br /> m <br /> m <br /> :\ <br /> rnr aid S. <br /> 9 vrJia c: <br /> y w < m <br /> z oom nam <br /> i <br /> boo OM <br /> .............. ............. . ..... .Fye ' ..... a <br /> Signature of Ow <br /> or Agent G'Date f .I <br /> Remarks . .M. .A.. ..li..l7.t: 5......,f. T.....QIg.�r.�4........./....Ip4r�. .....�.A ...�r-......Or....AUil..0�N�N ....... m <br /> v <br /> /�'ROP..02..T.J. F�S............................................................................................................................... <br /> ......................................................................................................:.... ................. ... ....:.9. ......,................................... <br /> Inspection Date ....................................... ... ............ ,i •L' o m <br /> Zonin Ad I strator 8 8 8 8 8 <br /> NOTE: A preliminary site inspection must be made and ite approval granted on all structures involving sanitary facili tie. <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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />