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• <br /> /' � � ;i , y <br /> Burnett County Office of Zoning Administrator -0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> Ss), <br /> ihown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co c W <br /> Jrdinance, Sanitation Code, and with all other applicable County Ordinances and t ws and regulations of the State of Wisconsin. 3 a F .is . <br /> 3E <br /> C' <br /> JWNER (pease print) \ m <br /> CONTRACTOR or SURVEYOR or AGENT v <br /> . "J <br /> ADDRESS ADDRESS <br /> Kt <br /> • <br /> DDRESS ADDRESS <br /> ei q next 6ci tre- ki/ lc _,..0 <br /> 'HONE PHONE <br /> N . <br /> 'LUMBER WELL DRILLER Z <br /> DDRESS sJ ADDRESS o Ni.-- l <br /> 'HONE PHONEZ ? •• '..c..... <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° ~-i. <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New CD Building Type,�. f Construction: No. Bedrooms c <br /> / <br /> Addition 1 ' Yt^¢,.µ�-- Septic Tank Size Gals. <br /> Sanitary Size .2.`.1...... ft. x .2'1 ft. cS <br /> Filling Height Stories / 4a. Absorption Field Site: r <br /> Moving Area Soil TypeQ" <br /> Grading Slope ).> 7 <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ,').-,. O <br /> Privy home,garage, motel, etc.) Dry Well 'i;1 - < <br /> Well 04`- Seepage Trench <br /> Subdivision Privy <br /> Seepage Bed `I �1 C-� j _ <br /> Y c <br /> _ocation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road 1 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- '_li o_ <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING y;- <br /> iTRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. / .1 `` <br /> 5---,\.:' C <br /> 5. Lot Size: Fig. A. 6. Location1 <br /> I <br /> ; <br /> ft. x ft. — sq. ft. t.N F ._ e� �� <br /> r, ,--' <br /> ----;N <br /> t 7' n <br /> r+ <br /> N \ 3. <br /> ( Y1 ° o <br /> m <br /> o <br /> N <br /> 0 <br /> r) 7 <br /> 7- <br /> '-------- }c��a Li Q -. <br /> i <br /> `l <br /> �� /� (-------- (''. ( IO o >7 <br /> i ik)!Cull A *it 017 <br /> ili7 <br /> CD <br /> f2-& C <br /> DJ cnr7* tncoz <br /> c m m <br /> n fn 0i 7 < N -• <br /> CD. Naa < - 7. n. <br /> -6 C.TI < c °i 7' 0 -0 <br /> '* 0 ti cn G cn * m <br /> Z oo* `D . fD X/ <br /> o. 7 = E <br /> •gyp of fcsm —1 <br /> o <br /> ..4/t v <br /> iig e of Owner or Agent Date ° cf• C <br /> 70 <br /> R• arks l in.0 71e/ too 1%0 to , e a-cldo•,,-71-0 or a A/ C) r '--€, - CD X m� <br /> CD <br /> 5/9-A-•� i 7L �v �., <br /> ,:5:7 -Na <br /> �D -e'f� /Low ?-o �,/(,u�.,.� - I"-, // iPtC/u-e___ toV 9.3 ii <br /> it. <br /> 7 plo. ,al....re)4)A s - v <br /> I <br /> c. 07 -a TI <br /> Inspection Date .its /7 c o 0 0 0 o m <br /> bbbbb m <br /> Zoning Administ .tor o o o o o o fI) <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any bulki- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> 'ith 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 />