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Burnett County Office of Zoning Administrator d 2� 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3' o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < N <br /> shown herein. The undersigned agrees that all work shall become in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a 6\. <br /> /-1.�t.t.Ve.. . ..7•.... h.A.G✓I..PS.t2 ........ ........................... ... ........ .... ... ...... .... ............................ a _ <br /> OW ER (please rind CONTRACTOR or SURVEYOR or AGENT a <br /> ....1©...:/....7..........ldtl.•.....L-A..uJ.. .:....r1...YJ................ . . .............................................................................. a <br /> ........ . . [ <br /> ADDRESS Y~ ADDRESS <br /> sh. . ?.►^.e. C.i...e.u?......../1!l.tU.:...5., 11a... ............ . . <br /> ADDRE S ADDRESS ' <br /> / <br /> PH... . .1..l1.5ti1�.......... ..�...`Y:.. ..I.. .....l...d............ PHONE <br /> U ti! <br /> a.de..r... �k....../ o. .. G�:.N.s................. ............................................................................................ <br /> LUMBER WELL DRILLER <br /> W...E..1z5.1 . .x .t.....W.�....... �` . .�1` ..... <br /> ADDRESS ADDRESS iCn� » LD <br /> ..................�1. 6........`.�./-5. ................................. o ° <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: � o 14 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details "'/ <br /> New Building ..X,... Type of Construction: No. Bedrooms ...I..... r \. `c <br /> Addition Septic Tank Size Gals. . 5.40 <br /> Sanitary �... .ft. x . ... ` <br /> ..,TC... Size .. ... . a� `X.... ft. <br /> +� 4a. Absorption Field Site: <br /> FillinglGrading ,,,,,,,,,, Height.Gl..S... Stories ...�...... l7 <br /> �7(Q '�'_ Soil Type .................................... ;© r <br /> Moving .......... Area ..... ..G9�.. ....... . o <br /> Mobile Home . ... 0. Slope .......................................... .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Y e� <br /> Well .......... home,garage, motel, etc.) Dr Well .......... p .� <br /> Subdivision .......... Seepage Trench .......... <br /> Camping Unit <br /> Privy .......... i <br /> Seepage Bed •C :(? <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc_ should be sketched in Fig A. Include road A Q iG <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o; <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING `• a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. SC i --- O (� <br /> ---------------------------------------------------------- -- .y <br /> W <br /> 5. Lo 4�jii d Fig. A. 6. Location: c ' <br /> . .T. ft. x .til ft. — ............................... s4.ft. <br /> sec...i�...P.M .a.ara..TwN...41Q. Re�G.IS <br /> N <br /> 0 <br /> E <br /> N O <br /> OQ, <br /> \ IA <br /> �j ? <br /> T <br /> 11^^ <br /> P&0 � <br /> a if'1 <br /> Os; u <br /> m <br /> o <br /> pin -F <br /> r 9J o 70 <br /> c m <br /> Kms.. <br /> ignature of 0 r Agent Date <br /> X 31 <br /> Remarks .............................. m <br /> m <br /> as <br /> ........................................................................................................................................................................................ \ II <br /> ............................................................................................................. . ............... enA <br /> O <br /> �J <br /> Inspection Date ....................................... ..... ......... . -.................. : : o IN o F, o u, m <br /> Zostrator $ $ 8 8 8 8 n <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 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 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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />