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---e:9-7-7 G '' 17 <br /> Burnett County Office of Zoning Administrator iv - o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ,?.. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 9, Q <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c k <br /> Ordinance, Sanitation Code,and wj?J5all of pplicabl County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> J ,/ II h a O <br /> gqf Th M 17 /'�o,e,i j A/Y1iehAi - N • <br /> a' -F.. <br /> OWNER (please rint) CO TR OR or RVEYO or GENT _ m CD <br /> /0 � Ko 41 E ' el &�h )fti d .��-�� -- <br /> AD KESS j i ADDRESS <br /> 1. t :s1 <br /> ADDRESS / ADDRESS <br /> PHONE PHONE �l1 <br /> ft N <br /> PLUMBER WELL DRILLER Ai <br /> v <br /> ADDRESS ADDRESS <br /> GI <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: • o ° <br /> 1. Work: No. Bathrooms (, 7 <br /> 2. New Building Details <br /> New Building Type of Copsstruc�n: No. Bedrooms .... m ?� <br /> Addition iv- tNC/o. it As../.1.N..G J/ECJ' Septic Tank Size Gals. /020 e <br /> Sanitary Size /l,�d ft. x S'!.3 ft. <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type o <br /> GradingSlope ,-+ <br /> Mobile Home 3. Use (describe exactly-family) Perc. Rate <br /> Privy home,garage,motel, etc.) Dry Well <br /> Well Seepage Trench 1 <br /> Subdivision Privy <br /> Seepage Bed ILI <br /> w N <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road I c <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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o' <br /> 5 <br /> 5. Lot� Size: (�� Fig. A. 6. Location: C. <br /> G74 ft. x D ft. — sq.ft. <br /> —'171 <br /> N <br /> (4 " <br /> C) <br /> (� N o. <br /> see iq )1-axivck D v-0,-P-mk. <br /> 5. <br /> tv <br /> 7 0 W <br /> N <br /> e h H <br /> t`LAI <br /> It. ?1^lV <br /> Z <br /> O o <br /> 0 <br /> c <br /> cno <br /> cn <br /> N <br /> fa <br /> Dzi cnr �* c1)ooz <br /> cp C co _ ct, m C CD <br /> co. N Q a< ,,-? C <br /> C cn5.c 5. 0 <br /> z oo'D : : m <br /> o z — 70 <br /> 1 v, <br /> 11 <br /> • <br /> 0 <br /> / m <br /> ii • 1 a <br /> Signatu of Owner r Agent Date ° C <br /> X X) <br /> Remarks - T m <br /> CD CD <br /> v <br /> TA <br /> 04 • <br /> TI <br /> Inspection Date ,"� 0 0 0 - - N m <br /> Zoning Administr or o o o = o C <br /> VOTE: 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 /> :his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ng 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 />