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tt-yu c: JTV (2 . <br /> Burnett County Office of Zoning Administrator 0 0 o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 7 3. N , <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as -. <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CID 2 <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin 3 a p,}\ <br /> PI4gsst, 11 4ti ; Q,, s d ; <br /> OWNER (please print CONTRACTOR or SURVEYOR or AGENT _ 0 <br /> cr, <br /> ADDRESS QQ ADDRESS 7 <br /> rr ruk t "11 Ss, o3 \V��� ,c <br /> ADDRESS ADDRESS `\�xS pV <br /> 1010 <br /> b A <br /> PH�E PHONE <br /> PLUMBER WELL DRILLER <br /> °D o <br /> ADDRESS ADDRESS / ti..) N CD 0 — <br /> 5 < <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: p <br /> 6, ° ..":4:1. Work: 2. New Building Details No. Bathrooms U1 0 p V <br /> New Building Type of nstruction: No. Bedrooms L 'J O <br /> Addition a ' ^'`L Septic Tank Size Gals. J7, j" <br /> Sanitary ...:?C... Size ...J.i(J ft. x ...A.7.. ft. 7a • <br /> 44k- <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type <br /> Grading Slope �� P <br /> Mobile Home 3. Use (describe exactly, famil Perc. Rate t----- .n <br /> Privy home,garage,motel, etc. Dry Well <br /> Well Seepage Trench q J-3 <br /> Subdivision Privy C 0 t <br /> Seepage Bed /.,z).X,Pa , -14) <br /> cn` . <br /> • <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road ` 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- Ci Q-, <br /> lak <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING .. L.` NY— <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i ` p'• '\ <br /> J <br /> 5. Lot Size: Fig. A. 6. Location: C. <br /> y <br /> ft. x ft. — sq.ft. •• r <br /> .Q <br /> 1 �E.. " <br /> 7 <br /> A ca <br /> o 7" C - <br /> P <br /> --- z . <br /> Ck 1. faxa -- --- n s`' 4110Irr cn <br /> v Li .15° 0 <br /> IS <br /> T Do <br /> t Co <br /> CD <br /> • <br /> n\we1 ) 1„ v xi cp cr -o�� .. f" <br /> CD <br /> CD, Naas - 7 <br /> cn <.0 � <br /> �' oa'th <br /> 0 • � m <br /> ------'-----di. <br /> I� o 05 fD ' m xi <br /> ��1.?" idr -' �_ <br /> - _`\ c <br /> 'moo t'cl <br /> e.Q0 7p <br /> p <br /> Signa re of Owner or Agent Date o C <br /> X <br /> Remarks m rnMi <br /> CI) <br /> CD <br /> p � c . , m <br /> Inspection Date \0 0 0 0 0 0 m rn <br /> Zoning Administrator !- v 00000ow <br /> VOTE: 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 /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> Nith is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />