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cP%7 G61a <br /> Burnett County Office of Zoning Administrator v0 Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3 ; W <br /> TO THE-ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and loosed as '1 — 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lard Use m t R <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisc)nsin. 3 a "` <br /> BETTY B:tOl'`N A;3LYN J. HELM <br /> ° <br /> ............................................................... . ................................................................................. ........ <br /> OWNER (please print) — ! 3 <br /> rr�� CONTRACTOR or SURVEYOR or AGENT o. m <br /> ADDRESS <br /> �.C+.!..(.O..BOX...51'I'5Y...................................... .ADDRESS P.O.BOi...7�-....................................... ........ a :� <br /> RBST ,....i?L5. <br /> .. .? $93. <br /> AooPOON '3:.... iL..54801 — too <br /> Ess <br /> ADDRESS <br /> [ <br /> ......................................................................................... . ................................................................................... ........ <br /> PHONE PHONE <br /> 1 <br /> A LYN.„J. HELMDel ; <br /> ......................................................... ................................................................................... . <br /> PLUMBER WELL DRILLER <br /> .........�'.r.9..,.150...71...... POON, 3 .......1I....rMg;0 . . . o <br /> ADDRESS ADDRESS <br /> cr o <br /> ..................7.75-.x.35...7.595....................................... ................................................................................... ........ a <br /> PHONE PHONE n <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms '9 <br /> New sending .... Type of Construction: No. Bedrooms . .. ... ;� <br /> Addition .... .................................................. Septic Tank Size Gals. DQ.0 <br /> Sanitary Size ...... ....... ft. x ......... ft. . ........ 1 <br /> Filling/Grading ........., Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ........................... ........ r <br /> Mobile Home .......... Slope .... ........ : 0 <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ............... .......... ........ <br /> Well home,garage, motel, etc.l Dry Well ... <br /> Subdivision „ , Seepage Trench ..}r6. w <br /> ...... .................................................... <br /> Camping Unit _......... Privy . ........ <br /> .........................................I.......... <br /> ___________________ Seepage Bed ...... . <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig A. IncludE oad C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ITIT <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXIS rING I < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. (�4–�J, ”' <br /> ___________________ --- ----------------------------- <br /> `J . <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. ...................................................................... ........ <br /> SFE ATTACHED SHEET <br /> N p <br /> O <br /> 7 <br /> 0 <br /> n <br /> 0 <br /> 0 <br /> s <br /> Z <br /> 0 <br /> d <br /> m <br /> X N r n m Z <br /> n is,c, -a Z m c m <br /> F <br /> on <br /> ,. =. m •c m �. m <br /> Z 0 a a <br /> SEPT..2,1.98.7... �� A <br /> . . ...... . E c_ <br /> Signature o Owr ....... ....gent Date J .. <br /> X : : : <br /> Remarks m m <br /> .................................................................................................................................................................... .... 0 <br /> e» <br /> ...................................................................................................... / <br /> .. ...... ............ .................................... ............. .... . . . . <br /> m <br /> N N N m <br /> Inspection Date ....................................... :lP.eAJ..Gr.....7> .�.. ....... ..., . ........... ... Pk U U o .*( o ra <br /> Zoning Admin stf rator 8 8 0 $ o o !m/f <br /> NOTE: A preliminary site inspection must be made and 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 lest must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plu 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 thi Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />