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--^•7-7:_4--yi 70 <br /> urnett-,CO unty Office of Zoning Administrator cn s � 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 74.RI 3. <br /> o <br /> 10 THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < y -^ <br /> • <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co C r^ <br /> Jrdina c , Sanitati n Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a ' Y ?LJ <br /> _ a <br /> �. 0 <br /> '//", d <br /> `J f' / d f� 0 <br /> AR"o / a. ( C - L� <br /> JWNER (please print) 6 ��m CONTRACTOR or SURVEYOR or AGENT <br /> CD CD <br /> [.S PPiVNe 0 .;'-c Sy 3 TIa- ._ t <br /> 'a <br /> ADDRESS� ADDRESS / �^ w <br /> ( s /'.. ss 3 -a hie s 7 (I- /0 y/ <br /> ADDRL7SS ADDRESS V.. . <br /> PI-IklE PHONE ,� <br /> .. �. fl <br /> 'LUMBER WELL DRILLER *\ 9• <br /> 1 <br /> `a v <br /> ADDRESS ADDRESS .. CD o 0 <br /> 0 < N <br /> PHONE PHONE Z H r 3 <br /> DESCRIPTION 4. Sanitary Facilities: P o ° ,O <br /> h Batrooms <br /> 1. Work: 2. New Building Details No. <br /> Newo <br /> ,,,c Type o Constructi No. Bedrooms on: 8 <br /> Building - Septic Tank Size Gals. t <br /> Addition h� � <br /> Sanitary ,, aZ <br /> A� Size .. .sa.... ft. x ...S.. -- ft. N <br /> Filling Height. . Stories 4a. Absorption Field Site: \ <br /> Moving Area Soil Type nIL r Slope <br /> °� o <br /> ,- <br /> Grading Perc. Rate ts <br /> Mobile Home • 3. Use (describe exact) <br /> ialeMP Privy home,garage, motel,etc. Dry Well Op ,. <br /> Well Seepage Trench 0-- <br /> Privy -k• <br /> Subdivision Seepage Bed j .• <br /> yn <br /> sk cn u r <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road 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- co <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING v Fl•<.,, <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. _' <br /> 5. Lqt Size: Fig. A. 6. Location: L'1 E <br /> ../O' ft. x ...(ei.r. ft. — sq.ft. <br /> ' I <br /> o <br /> s. <br /> 93 <br /> 4,1 0 <br /> ‘rr <br /> 0.j."-CP .1 <br /> O t <br /> Z7 <br /> n) <br /> 7 <br /> CO <br /> CD <br /> Z7 cn r * cn .. Z <br /> CD C DI _ CD 3 CD <br /> CD. Nao.,<c = •P ., - <br /> 'O Ut Z. c co .' ID <br /> Z 0o' fD `D <br /> • <br /> . _ <br /> I o..., . -i <br /> ci) ,,,,, _ , c �. m <br /> Signature of Owner o�� ent �y Date / / 0�* -- <br /> Remarks 4�` s P� �� , % �e e -4 /BLS x : m <br /> CD 0 <br /> ,..4)jy/� 11 II O.Inspection Date �� C C C m <br /> co Cr <br /> ZoningAdminstr o cow 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 />