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IX.o�r. <br /> Office of Zoning Adminis rator d no 0 0 <br /> ?PLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 9 <br /> ,KING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < m 0 iJ <br /> i ierein_ The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation)Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis opsin_ 3 p, <br /> ....t.J..R.M.............4.... :.C.. ant..t..l't............................... . .......................................................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m m <br /> .............. .....Z.. ........a.in. .....3.. ............ .......................................................... ................................. a <br /> ADDRESS ADDRESS <br /> _ m <br /> �.��.A.*��N. ..E.2............�t�..t..... S.. CY..QJ.. . .......................................................................................... <br /> ADD ESS ADDRESS <br /> `7.�.s-�.......... .. f..a......-....7..a..i.1............ <br /> PHONE PHONE ' <br /> ........................................................................................... ' <br /> PLUMBER . .......................................................................................... <br /> WELL DRILLER <br /> ADDRESS............................................................................ . ... . . ...................................................................... <br /> AD.D.RES. S O <br /> m LD <br /> ........................................................................................... ° <br /> 1 <br /> PHONEPHON.E................................................................................ ? � <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2, New Building Details No. Bathrooms ...X.f <br /> New Building ... Type of Construe ion: ( No. Bedrooms Atldition .. Septic Tank Size Gals. ........ <br /> Sanitary ......... Size ...X"..... ft. x ..:l..2.... ft. ........EillingiGrading .......... Height............. Stories ......I. ..... 4a. Absorption Field Site:Moving . ........ Area Soil Type .......................... ..................................................Mobile Home Slo a ....... o <br /> .......... p ................................ <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ......................... ......... <br /> Well ,,,,,,,,,, home,garage, motel tC.) Dry Well ......... <br /> Subdivision �pe_vt � "A Seepage Trench <br /> Camping Unit Privy <br /> _ _____ Seepage Bed ......... i <br /> _ P ——————————————————— -----------------------------___---__ <br /> Location ofproposed <br /> --- V1 <br /> pro osed structures and existing structures, well,sewage systers, roads, etc., should he sketched m Fig_ A. Inclu.e road LU <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a hlghwa inter- _a <br /> section, show the Intersecting highways and the setbacks required along them and at the 'intersection. CLEARLY LABEL EXISTING Q S <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -------------------------------_---_------------------_------------- --__ <br /> 5. L Size: Fig. A. 6. Location: o <br /> J&-.t?E ft. x .............. ft. — ............................... sq. ft. ... .......................................................................... <br /> R/c6�C . ✓aiT <br /> o L <br /> Zoo 0 <br /> I <br /> c Ekl ) i/N6 <br /> V <br /> /( 0USG z <br /> 0 <br /> R S�i? c- <br /> T Al <br /> m N a a = y as <br /> ato < F ' ,� �' v <br /> o ' <br /> M <br /> z o <br /> O _ 0 n 7J <br /> t» a 3 <br /> o _ <br /> 30 <br /> ..... �0 .. ....� ....... oQ <br /> ....................... m <br /> nature of Ow er or Agent ate (7 0 C <br /> Remarks ............................................................... ... . .......... ... ............ ............................................. ..... — <br /> X <br /> 7J <br /> T <br /> may) �—�^ �yy� <br /> .. IM <br /> ...........:s*. ......, ;! 11.. ..... ....:.1 111. ... m <br /> .................................................................................................. ... .................... . ............................. ..... <br /> Inspection Date ....................................... ..... ... ............�... �,� . ... ..::...... .. ..... U <br /> T <br /> NOUo m <br /> Zoning Adminis or $ $ $ $ $ to <br /> NOTE: A preliminary site inspection must be made and s e approval granted on all structures Involving sanitary fac.ilitius <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 airy flu Bing 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 Adm inistiatoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />