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Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. o <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as < 7 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use pG <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin 3a <br /> .. . . ') . <br /> ............... .... ........ . .. . <br /> OW ER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> ADOREs f / / ADDRESS •* <br /> V!U 11 t. ..1�.1.M.i�.....-.. `�.y.......... <br /> ADDRESS ADDRESS <br /> PHONE................................................................................ .PHONE................................................................................ <br /> p� <br /> ............. <br /> .WE...........R.I... . <br /> LLER.......................................................... nC N p r� <br /> PLUMBER LL D �f <br /> O <br /> ........................................................................................... ............................................................................................ _. <br /> ADDRESS ADDRESS » o <br /> o <br /> ........................................................................................... ................................................... ....................................... : <br /> PHONE PHONE Z '^ r <br /> DESCRIPTION 4• SanitaryFacilities: ° o ° <br /> """"" <br /> th <br /> Barooms <br /> 1. Work: 2. New Building Details No. o :L <br /> New Building Type of Construction: No. Bedrooms ..... <br /> .......... ..... L <br /> m :L <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... :�� <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... :`ry <br /> Filling/Grading .,........ Height............. Stories ............... 4a. Absorption Field Site: <br /> SoilType .................................... <br /> Moving .......... Area ........................................... Sog � <br /> .Mobile Home Slope .......................................... o <br /> b 0 <br /> .... ..... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> C <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision ... .................................................... Seepage Trench .......... 'J <br /> Privy <br /> Camping Unit1. .. Seepage <br /> .......... <br /> eeppage Bed .......... N 3 <br /> ------------------------------------------------------------------ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc_ should be sketched in Pig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- vu 9, <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r C,i L* O a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS o <br /> 5. Lot Size: <br /> Fig. A. 6. Location: o \ w i <br /> ........-...... ft. x .............. ft. . ............................... sq. ft. .............................................................................., ° \ <br /> o <br /> Camping Unit <br /> July 22, 1985 through January 22, 1986 <br /> N O <br /> O \ 7 <br /> 3 <br /> O :X <br /> ��1 0 <br /> ;arV <br /> N � S <br /> Z <br /> m <br /> m <br /> U\ <br /> JJ <br /> es, l N r v � m W Z <br /> < <br /> m = n <br /> en 2 <br /> Z 00 � Da m <br /> o n 77 <br /> �i <br /> XeoOwner or Agent Date X <br /> Z,,,, �� v /Y T : o <br /> Remarks ��. ............ ................. ... ......................................................................................................................... _ <br /> m <br /> ea ' <br /> ........................................................................................................................................................................................ ` II <br /> ...................................... ....... ...... ........ ..... \ <br /> (�' ` c' ' gm <br /> Inspection Date }f.. �... ................................ g o o S m <br /> p ....................................... GG7'n.�.0.. ....:......... . elf.................... 0 0 <br /> Zoning Administrator /-J !�: <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilltics <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 revoker) if misrepresentation of any of file information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoniny Administratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />