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U'I?CCIVp z-K' . <br /> Burnett County t '6Y'Pomn dministrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE BUILDING PERMIT d 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application fora Permit for the work described and locat d as < <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 Wisco sin. 3 o- <br /> L..A. . . .....G , <br /> ........... . .............. ...aw. ..E... ....................................�.. ... _ <br /> ._: a do <br /> N N <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> .zJ.� ...C�E.S.T...G!.00.Q........ .N a `�h <br /> ... .......................................................................... ...... <br /> ADDRESS ADDRESS <br /> � : <br /> �t�.....9 2 G 3.Z............ �^ <br /> ..........................................................................i...... <br /> ADDRESS ADDRESS <br /> ��.... .-.-�..�`... d.9.................................. ............................................................................................ <br /> PHONE PHONE "` <br /> N..Q.T....... ...........y. .r............... 2222... . . T D y0 .. ....... J r <br /> Nor......SEGEc ,.E , <br /> T <br /> PLUMBER WELL DRILLER ;-�. ; <br /> ADDRESS ADDRESS m V7 m <br /> n p <br /> O........................................................................................... ............................................................................................ ri <br /> PHONE PHONE 0 <br /> DESCRIPTION 4. Sanitary Facilities: �// ° o <br /> 1. Work: 2. New Building Details No. Bathrooms ...`•Z o '� <br /> New Building ,.k,., Typey f Construction: No. Bedrooms A. a <br /> p p <br /> Addition .... ..... ..........F'.f}.!!'� ............ �s. < 'U <br /> Sanitary .. ....... 3 . ).,... ... t. .. ....... <br /> Size .. ,;. ... f . x 2222. . ft ; <br /> Pdlingo Grading .......... Height..$.`.i. . tories 2222.1........ 4a. Absorption Field Site: O : 0 ; <br /> Moving .......... �A+rea .f"�:. 5 ..�.,�3 Soil Type ............................ ....... 0 <br /> Mobile Home C7Qti#�t28'y.3G -100$ Slope .................................. ....... y <br /> Privy „ ,2222.. 3. Use (describe exactly, 1 -family Perc. Rate ........................... ....... <br /> Well ,�.... home,garage, motel, etc.) Dry Well .. ....... <br /> Subdivision ,,,,,,,,,, �Lr Seepage Trench .. ....... <br /> 1.....FFEnt...... ......Fk ,. ...... <br /> Camping Unit ..ti.1.1.T 1..../ T.7..W—ff ..... Privy .. ....... <br /> ____-_______________________ /.�1Q �F. C�______ Seepage Bed_________. ..- <br /> J T —1 1E ON <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched In Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- a <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXIS ING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---_--_.------------------------------------------------------------ -- ll <br /> 5. Lot Size: Fig. A. 6. Location:n A <br /> .1.42.0...... ft. x;;UT� 2 ,aft. — ... .130.0.......... sq.ft. ...............N.GI N,E;F,R/;!'1.......47A.k)..... ........ <br /> (j <br /> m <br /> P �' <br /> 0 <br /> p o <br /> o <br /> Z9 <br /> � l Sy -%7.Z <br /> T <br /> 0 ? <br /> 4 � 77 fn r v y m 2 <br /> C a m ,9 <br /> m <br /> O y n <br /> 0 <br /> �0 3 <br /> o y <br /> .9... ... . .... ..... �l.Y...� �....... f C <br /> ature pof Owner or Date C <br /> Rem rks.l..Lu.l(.cin cae•e.✓. ?`.aa.3..... ......................... . .................................................................................. ..... X M <br /> ''. . ... y r)i f_Fh �:F n;r:..T....:� !r�:. 3 <br /> .)q.................................................. ... . <br /> M <br /> n <br /> . ....,.......................... ..... <br /> it f <br /> Inspection Date yA//� J ro <br /> ....................................... .... ................i:.F...... ........ ................... 2222. ,uNi tiro P°noa <br /> Zoning A inistrator 8 808 8I8,}n <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures in olv my sanitary facilitles <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 plu ring or start any build- <br /> ing until a permit has been Issued. A permit may be revoked If misrepresentation of any of the inf rmation 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 />