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.-c^�72 ,:::C77- , <br /> t'-/'' l <br /> Burnett County Office of Zoning Administrator CO CO 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m' ;. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '- v, 9 <br /> shown herein. The undersigned agrees that all work snail be done in accordan.e with the requirements of the Burnett County Land Use ;IF c C <br /> Ordinance, Sanitation Code,and with a`ll other applicab�(minty Ordinanc and the laws and regulations of the State of Wisconsin. 3 a <br /> /49 AI r <br /> R. <br /> t_ .41,,,, --(7."4,Y.- r7 gf * <br /> OWNER lease prir� CONTRACTOPI or iEYOR or AGENT Q fD <br /> II I <br /> Z <br /> ADDRESS ADDRESS v <br /> `4) i <br /> ADDRESS ADDRESS ` <br /> y, 6 - gs8V <br /> 3 <br /> PHONE PHONE <br /> Nrs <br /> PLUMBER WELL DRILLER <br /> 0 N <br /> ADDRESS ADDRESS , G) <br /> 0 o <br /> 6 , <br /> PHONE PHONEz N r <br /> DESCRIPTION 4. Sanitary Facilities: ° .- 0 <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Construction: No. Bedrooms CD <br /> Addition .,., Septic Tank Size Gals. J ,.„..< <br /> Sanitary Size ....1.9.,... ft. x c2 L( ft. <br /> Filling Height Stories / 4a. Absorption Field Site: O <br /> Moving Area Soil Type OJ o <br /> Grading Slope / .* <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate .. <br /> Privy h me,garage,motel, etc.) Dry Well W <br /> Well, bed t-ooms- Seepage rench U1 <br /> Subdivision Privy <br /> Seeps a Bed <br /> rn <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road R4 c <br /> O a� ,'! <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property 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 O < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> 5. Lot Size: 56 /9ew5 Fig. A. 6. Location: <br /> ft. x ft. — sq. ft. 1 <br /> Nicn <br /> Ir c . <br /> C) <br /> ._, <br /> N O' <br /> O 7 <br /> 7 <br /> (0 <br /> 0. <br /> S <br /> O <br /> y T <br /> C O <br /> 0 <br /> )- n 1�r� <br /> I (4) ' ,101 . N H 0 WY- <br /> 509L— <br /> 'y 7 <br /> , <br /> CD C� mac° 3 OD <br /> fD. Naa< — .: a <br /> �� VP• 1� 22Ouf > o cn < c 0' 0 � <br /> 1! �* oN N < (n * m <br /> a�i Z 0a' fo : : m m <br /> i , 0.42 - PM ch 0 rs-' • te E <br /> ( <br /> 1- I)-xa•, dis o -I <br /> Qd 'er."‘ '--•/S- - F7' W (-D, m <br /> Signature of Own .r Agent Date o C— <br /> L 2r �" / x XI <br /> Remarks - rtet°d kr"( m-�-i��'�`3-1( � r2 e lasil � roo"+s f w'R, „ rn <br /> (� <br /> II <br /> CD <br /> 0 <br /> .iq.Ivv tGlai+er-S a-C.14 beAroor v- <br /> b u <br /> T1 <br /> ,frr <br /> Inspection Date .,- r'ft� c o 0 0 0 0 .c`n rm <br /> Zoning Ad istrator o0000oc.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 />