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Burnett C9unty Office of Zoning Administrator iu 3 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT _ <br /> a' <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as < — ;pp <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> a <br /> _ m O <br /> ........Sw.A. .......................................... ...... 9ry/.x.~-......1-.. e....................I..................... �v <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT is <br /> ........��.. .....1 'C) �3L� r, U. /r'ut'�....�/ an 1 ipl <br /> o..K..................R............................... .......... .......a... <br /> ADDRESS <br /> S•S : . . ADDRESS S <br /> ........ N /......tS-zl..PO./..................... .......spedee- <br /> ...................... <br /> i.............................................................. <br /> ADDRESS ADDRESS :Vit <br /> . ............................................. <br /> _ lJ <br /> PHONE PHONE <br /> ��r�./ N.......T. ..... r�/el. ................... <br /> PLUMBER [� WELL DRILLER <br /> ........ ......�.ox....7� :...J.hgdN cR. . G✓ S ,• (9/ O i1t <br /> .f...... ..:.. . ..................................................................................... <br /> ADDRESS ADDRESS m 0 <br /> :Z <br /> 7/ (- ° o <br /> PHONE PHONE Z H <br /> DESCRIPTION 4. Sanitary Facilities: P o ° <br /> 1. Work: 2. New Building Details No. Bathroomso ~ <br /> ........ <br /> No. Bedrooms G' . a <br /> New Building ......,,,, Type of Construction: ••••••••• <br /> Septic Tank Size Gals. 7rV a <br /> v.... Size ft. x .............. ft. <br /> Sanitary .!� .............. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .......S,V..*—f................... i :91 :r- <br /> Mobile <br /> Mobile Home .......... Slope ..............`.'.�. .................. i4� o <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Pere. Rate ..........!7!. .................. <br /> Well .......... home,garage, motel, etc.) Dry Well .......... .F-- <br /> SubdivisionSeepage Trench .......... ice. <br /> Camping Unit .......... .................................................... Privy .......... <br /> .................................................... <br /> Seepage Bed /?.K..v',?'" <br /> ---------------------------------------------------------------------- ''� •tn (A <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road r Q p11y <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- °- <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING w <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. , p' <br /> 9 <br /> ___________________________________ ?'� � <br /> 5. Lot Size: Fig. A. 6. Location: lJ <br /> 151,'X../szU ft. x .z.Y.P.... ft. — ............................... sq. ft. u,.R..twAT..-V ?V <br /> >j :a n <br /> N <br /> o Y O <br /> h- <br /> _^^\\11'� o <br /> lV <br /> 10 <br /> m ie <br /> V/ G <br /> Z m Z <br /> Y/ <br /> o <br /> d <br /> X <br /> M rnr v Mm Z <br /> nQ < c m <br /> M 69,jd � `� <br /> Z oo' : nm <br /> a717 <br /> o ° am � <br /> P—) mIo <br /> 17— 8 p <br /> Signatur�er or Agent Date <br /> X <br /> 4fi <br /> . .......... . . . . . . . . .. . .. m m <br /> ./.......... .Remk ......... n . ..... ...... ...... ........... ..... ............ ...... .......... ........... .... . ..... ..... <br /> . ... . .. m ��' 0G <br /> .......... ...... : . .......... . ........... O <br /> L.. /i�,: 1...... `....................................................... ................................ 00°ll <br /> . ............. ..r• <br /> Inspection Date ..� .... .r�.-YL.............. .. ................ .......... U R <br /> ,{Jii oi'no <br /> Zonin A Inistrator 8 8 8 8 8 fn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> ration before a permit will be issued. Do riot purchase or install a septic tank, do any plumbing or start any bunt) <br /> •nit has been issued. A permit may be revoked If misrepresentation of any of the Information conveyed here <br /> <ist. Changes in plans or specifications shall not tre made without approval of the Zoning Adm inistratoi. <br /> .TEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />