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02? ce�2r <br /> Burnett County Office of Zoning Administrator fC c <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 'z 72 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 'a <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> I?a.� �..... .:.....leA. ............................... - - <br /> CL <br /> �L .................................................... tt » <br /> OWNER (Pease print) .................. � <br /> CONTRACTOR or SURVEYOR or AGENT s <br /> •52 <br /> ADDRES.... P.�... a..... 0 .............. . ..........................................................................................ADDRESS <br /> 71 <br /> ADDRESS <br /> A J F,l <br /> ADDRESSV. . . . ..................................................................................... <br /> ADDRESS <br /> ...&J2.-..4�10Z.- �ik <br /> PHONE .... ... . ................................. " <br /> . HONE................................................................................. <br /> PHONE — <br /> i iv i i <br /> � r . <br /> PLUMBER .W­*Ell <br /> LL.......... . . ....................................................................... <br /> DRILLER <br /> ........................................................................................... <br /> ADDRESS . .......................................................................................... <br /> ADDRESS — <br /> C <br /> ........................................................................................... 0 '. '•!)\ <br /> PHONEPHON ............................ ....................................... - » <br /> DESCRIPTION Z ^ r <br /> 4. SanitaryFacilities: ° o o <br /> 1. Work: 2. New Building Details No. Bathrooms ..... i <br /> New auiidinp •--••••... Type of Construction: No. Bedrooms .......... <br /> Add , ° ? _,Addition Septic Tank Size Gals. ...... ... a i <br /> Sanitary .......... Size ....f..Q..... ft. x ....J..4g'... ft. i <br /> FillinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... r <br /> Mobile Home o <br /> .......... Slope .......................................... <br /> Privy Perc. Rate ................................... m <br /> .......... 3. Use describe exactly,'t -family <br /> Well .......... <br /> .......... home,garage,motel, etc.) <br /> Dry We <br /> ll .......... <br /> Subdivision � <br /> o.� Seepage e Trench .......... <br /> Camping Unit ...................................... Privy .......... m <br /> g '• <br /> Seepage Bed <br /> .......... <br /> ------ -------------------------------- --- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --_--_—_—___ __________________ <br /> 5. Lot Size: Fig. A. 6. Location: _ <br /> ....�5... ft. x . < <br /> Q. ft. — ............................... sq.ft. ..................rkL►c......f!.! k.4........................... <br /> ° <br /> N <br /> O j <br /> 7 <br /> 0 <br /> ° <br /> z <br /> Z <br /> 0 <br /> ]7 <br /> a <br /> 30° to <br /> APPRuc DECK <br /> 21+ — <br /> mvmr0 moo <br /> m. �a� — °. m _nay <br /> ic <br /> O O 7 p - i <br /> EXssry�s� !D b Na : y <br /> APP(vx <br /> f.... -..... .�ZS..-.. 7 <br /> w <br /> y <br /> ... ......... r x n : m <br /> Signature of Owner or Agent Date <br /> o <br /> Remarks <br /> m •• <br /> ........................................................................................................................................................................................ » <br /> No : o <br /> b <br /> .................... ......................................... ... ....,t/.l.....:........:. ........ <br /> o 0 <br /> Inspection Date ...................................... .................................... .\ , ..(:J..i�. �^:/.:v1............... N N J o U m <br /> Zoning Administrator ;Y r? S 88 i$ 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />