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!/--,/Y, <br /> Burnett County Office of Zoning Administrator o a <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR- The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done In accordance with me requirements of the Burnett County Land Use Is <br /> m <br /> Ordinance, Sanitation Code, nd with all other applicable County Ordinances and the laws and regulations of the Slate of Wisconsin. 3 a :p <br /> J nn 4 � •• d \\ <br /> 3.Y n.:�....... .. ..0 ......C'P S�a !'� ...........................................� <br /> OWNER (please printf CONTRACTOR or SURVEYOR or AGENT m <br /> R:.r.......1....... . ........ ..... ...... . ................................................................................. a ^•, ` <br /> ADDRESS _ ADDRESS EG iY` <br /> W Q.L.S.T.('.......�`i ' <br /> .......... <br /> ADDRESS ADDRESS <br /> .......................................................—................................. <br /> . <br /> PHp(VE PHONE <br /> 1 <br /> PLUMBER WELL DRILLER <br /> .................................................................................. <br /> ........................................................................................... p <br /> ADDRESS ADDRESS /� 0 0 o <br /> ........................................................................................... ....................................................... Z <br /> ...... ....... <br /> O <br /> .................... 'z <br /> PHONE PHONE r <br /> DESCRIPTION 4. Sanitary Facilities: P0 ° <br /> 0 <br /> 1. Work: 2. New Building Details No. Bathrooms ........ :� 0 <br /> New Building .......... Type of Cop ruction:— No. Bedrooms ....�..- v <br /> Addition .,......,, .: ,,,�'/S./i.ry.�......1/)f{.,/". Septic Tank Size Gals. .......... :rpt <br /> SanitarySize ..............,,, <br /> ft. x .............. ft. <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... o <br /> Grading Slope .............................. ........... <br /> Mobile Home .......... 3. Use (describe exact] , 1 -family Perc. Rate ................................... k <br /> Privy home,garage, motel, e Dry Well .......... <br /> WellSeepage Trench <br /> ...(/ ................................... .........I...... <br /> ........_ pG+ <br /> SubdivisionPrivy ....... iJ) i <br /> Seepage Bed <br /> _____________________________________________ ______ _____ _________ w <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in rug. A- Include road r.. C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If props rty Is located at a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING t A y u <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0' <br /> 5. Lot Size: Fig. A. <br /> ................ ft. x .............. ft. — ............................... sq.ft. J ; <br /> I .. <br /> O <br /> q` a <br /> � n <br /> IN 0 <br /> SU k <br /> / : <br /> F <br /> Zs <br /> n <br /> i <br /> 1 ':45� <br /> G on oa <br /> - � <br /> bar c:- a <br /> Ne, m <br /> 1 a cn <br /> Z 00 <br /> o <br /> ry <br /> 0 <br /> 0 <br /> S`.-s...-. ..?- CZ <br /> Signat re of Owner r Agent Date 70 <br /> M X § M <br /> Remarks ............................................................................................................................................................................ f0 <br /> PI: <br /> 4; <br /> ......................................................................................................................................................................I........I........... <br /> 4: <br /> iL n i i i i <br /> ............................................................................................................................ .............................................................. En <br /> `\ C <br /> car <br /> Ing <br /> Inspection Date ....................................... I ........C...(KA.GyrU-v✓................................... i in 0 0 ' D m <br /> Zoning Administrator 0 0 0 0 rn <br /> NOTE: A preliminary site Inspection must be made and site approval granted on all structures involving sanitary Lacilitu , <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached tU <br /> this application before a permit will be Issued. Do not purchase or Install o septic tank, do any plumbing or stout any huilll <br /> Ing until a permit has been issued. A permit may be revoked if misrmpuesentition of any of the information conveyed here <br /> with is found to exist. Changes in plans or specificatlons shall not be made without approval of the Zoning AdminisUatoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPC C ED 13Y THIS OFFICE AND APPROVED. <br />