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i <br /> Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT 9. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and M <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 `a <br /> regulations of the State of Wisconsin. <br /> .1 V1.1! ........ !"1.i................................ -[- ................... A <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> , T!4- .... c... . ...�� 3 .... ........................ a <br /> ADDRESS • ADDRESS . E�4 iLn <br /> ....... .5, °.��' (� . ..GV.. .................... ........... ci Lsll .. ..�C 1.L.................... ... E C <br /> .. ........ .............. <br /> ADDRESS ADDR�.IC. .S. d... ...7...0............................................... t <br /> PHONE PHONE D� <br /> ........................................................................................... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> ....................................................................... .. <br /> ..... A..DDR...... ........................................................................... 4 :�J <br /> ADDRESS ESS....... <br /> M o <br /> ........................................................................................... ................................................... ....................................... O w <br /> PHONE PHONE Z r— Fe <br /> DESCRIPTION 4. SanitaryFacilities: P o ° <br /> 1. Work: 2. New Building Details No. Bathrooms c <br /> .......... <br /> New Building ... Type of Construction: No. Bedrooms .......... <br /> Addition Septic Tank Size Gals. .......... <br /> ?S .. .......... <d04L ./E..................... < n. <br /> Sanitary .......... Size ...1.�... ft. x .... .a.. ft. i U <br /> Filling/Grading g <br /> .......... Height...8...... Stories ....../........ <br /> Moving .......... Area ........ Soil Type .................................... <br /> Mobile Home Slope .......................................... <br /> .......... <br /> Privy 3. Use (describe exactly, t •family Perc. Rate ................................... �m _ U+ <br /> Well home,garage, motel, etc.) Dry Well .......... iorF <br /> .......... <br /> Subdivision .......... — / Seepage Trench .......... <br /> ... .1.. F!.�f'!7.. ...........•..:. Priv <br /> Camping Unit .......... nt_{')�AX1...C1.17,'�D...S�.. L �. Seepage Bed . <br /> ----------------------- C�r .......... <br /> -------------------------------- (� E <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I p <br /> ----------------------------------------------------- . <br /> 5. lot Size: Fig. A. 6. Location: Lv <br /> ..laz.l..... ft. x .....3PP ft. — ............................. sq.ft. ............................................................................... <br /> m <br /> N O <br /> O <br /> L�1 F•l. i r t <br /> O �N <br /> � � J <br /> I I t L p ' iW <br /> -- ✓ '° €Z <br /> Z <br /> 0 <br /> d <br /> r <br /> 6PtKIx(db .N nr D m m <br /> 0 DD0 <br /> a< = m <br /> am = am aaJ1 <br /> 65 <br /> m pip a] <br /> Z�.o �2 D 1 <br /> 0 0 9 <br /> Co : m <br /> m <br /> 00 . 0 <br /> ...9.... �rA <br /> a9 .... ........... ....:✓�lv7.. .......... ,fix A : mSi re f wn gen ✓v Date E o <br /> Remarks ................................................. .. .. ...1/. '!...`.-r..r............`^..... ....................................................... <br /> .. .......................................................:..... ...... ..... . dw.....7.-..1.1...-. $"......................................................... <br /> U <br /> 0 0 <br /> g <br /> .................... ...................................................................... . <br /> Inspection Date .................. .. . . .. ,.... ,. . . . ....... 9, N . m <br /> ..................... <br /> Zoning Administr�........ g g g g (AA <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />