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�-;7 <br /> 3urnett Coun'ly Office of Zoning Administrator v CD o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> 0 <br /> FO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N — <br /> hewn herein. The undersigned a rees that all work shall be done in accordance with the re irements e B rnett Count Land Use c � ` <br /> nce,( nitation e, with all other El <br /> ble County sand the la s a d regul tion of he State o Wisconsin. 3 <br /> y . . . . <br /> 3Wu�lER (plea p tl ONT CTOR or R or AGENT a <br /> 2 <br /> D R..as CD <br /> . ......... ... . ... . :-� .. ....... . ...... 1.........c C �C.......... ................... <br /> c <br /> m t <br /> t........(.>✓.e ............................................. .-....�.��.".. ....... ........ ... c �� � ....... y�s30`" <br /> ADDRESS ADDRESS <br /> 'HONE................................................................................ PH 3.. .... ....�.��-S b <br /> ONE <br /> . . . ................................................................................... <br /> 'LUMBER WELL DRILLER <br /> ............................................................................ ............................................................................................ _. ° <br /> ADDRESS ADDRESS <br /> r+ < <br /> z o 7 <br /> 'HONE PHONE _ <br /> DESCRIPTION ° ° <br /> 4. Sanitary Facilities: r` o <br /> I. Work: No. Bathrooms <br /> 2. New Building Details o ; <br /> New Building „ •, TY e of Co st uction: No. Bedr s i <br /> Addition ,•„ (, D Se tic a k ize Gal <br /> ` r--� . .. <br /> Sanitary .......... Size ��...t ft. x .. .. .. ft. tv�(� <br /> FillingHeight...6..Wries ,� 4a. Abso pti n ie6 ite: <br /> ......... g .... ......... <br /> Moving Soil T e ........... ........................Area ..... ................... Yp <br /> Grading Slope .......................................... �� h 7 <br /> .. ....... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy ....•..... home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench .......... <br /> .................................................... <br /> Subdivision .......... Privy .......... <br /> Seepage Bed <br /> -ocation of proposed structures and existing structures,well,sewage systems, roads etc.,should be sketched in Fig. A. Include road C <br /> etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- M a <br /> ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> N <br /> iTRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. —' <br /> ------------------------------------------ ------------------------ <br /> i. Lot S'zel ti Fig. A. 6. Location: <br /> 1. .... ft. x .off. ,.... ft. — ............................... sq.ft. ............................................................................ .. <br /> fN <br /> • n <br /> N O <br /> /Ox/ S <br /> -o• <br /> ay?�a'� ICI 4 <br /> — ! ZC?1 -�— t z <br /> :l <br /> CD <br /> to ( I <br /> CCO0 <br /> � <br /> m N QO..•Gcn < C : ° <br /> oz;; H < La <br /> z C:) <br /> o <br /> o <br /> i <br /> d. ... .... Q�.. e~c. .. . E. /..c�..-.1..7.- 3 E o p <br /> signature of Owner or gent Date <br /> X 70 <br /> iemarks .7U....2e ?C a�/ y JP/ ............................................................................................. T' 0 <br /> m <br /> ,, ................................................................................................................................ <br /> ......................................................................................................... .. .................. .................................................... <br /> inspection Date ....................................... � J o 0 0 0 o cn m <br /> .... ..............................g.............f......... 1 <br /> Zonin Admirrfstrator r I 0 0 0 0 0 o 0 <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> ?fore 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 build- <br /> g 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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />