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L41?C <br /> Burnett County Office of Zoning Administ ator �o Z <br /> APPLICATION FOR SANITARY - LAND USE — BUILDING PERMIT � 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < m <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 Wls onsln. a i <br /> :O <br /> a O O <br /> Dick Frees <br /> ........ ................................................................................ ......... . . . ........... . ...........................I.......... ......... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m P <br /> Orantsbur WI840 a <br /> .................54..................................I........ .................................................................................. ......... a Zi :m <br /> ADDRESS ADDRESS <br /> ........................................................................................... <br /> �L' n <br /> ADDRESS ADDRESS <br /> 463-5483 <br /> PHONE PHONE ; to <br /> to <br /> .......PAnab.d...Danie.is.................................................... <br /> ....... :CO [ <br /> PLUMBER WELL DRILLER '. <br /> .......Si.ren.r...W.1.....5.!!$.72............................................... o <br /> _. <br /> ADDRESS ADDRESS G) <br /> n o <br /> .. ....46.3-2.333.................................................................. �. <br /> PHONEPHON..E...................................................................... ......... j <br /> DESCRIPTIONZ 0 <br /> 4. Sanitary Facilities: ° <br /> ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .2...... (.21_'l v <br /> New Building No. Bedrooms o <br /> .......... <br /> m <br /> Addition .......... .................................................... Septic Tank Size Gals. t OD.... K < <br /> Sanitary .......Size .............. ft. x ............., ft. ......... <br /> Filling/Grading g 4a. Absorption Field Site: ! <br /> .......... Hei ht............. Stories ............... <br /> Moving .......... Area Soil Type .......................... ......... <br /> ........................................... <br /> Mobile Home .......... Slope ................................ ......... :0 <br /> Privy ....... 3. Use (describe exactly, 1 -family Perc. Rate ......................... ......... �} <br /> Well .......... home,garage, motel, etc.) Dry Well ......... <br /> Subdivision ......... <br /> Seepage Trench <br /> .................................................... 7✓ : _ <br /> Camping Unit .......... Privy ......... <br /> .................................................... '3 <br /> Seepage Bed Mo .nd,... <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched .n Fig A. Includ. road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highwa inter- it a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLFARLY LABEL EXISTING 'S <br /> I o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i0 0 <br /> ---_—.._---_—___- ---------- --_----------------------__-----__.__------- —— <br /> 5. Lot Size: Fig. t. 6. Location: <br /> r• :� <br /> ................ ft. x .............. ft. — ............................... s ft. :w <br /> W o <br /> a <br /> WW1 <br /> v <br /> 0 0 � <br /> S <br /> � N <br /> See State approved plans o <br /> 0 <br /> t <br /> a <br /> m w <br /> �o <br /> Z <br /> 0 <br /> m <br /> m <br /> m <br /> E <br /> JJ Nr y u Z <br /> fA n — <br /> .Q' C m <br /> � M am <br /> o <br /> p <br /> Signature of Owner or Agent Date J E C <br /> X r M <br /> Remarks ......................................................................................................................................................................... m m <br /> v <br /> ......................................................................................................... <br /> II <br /> I�CGL7ll m <br /> Inspection Date ....................................... . . ...................... . .. ............... .. <br /> M <br /> Zoning Admi rotor0. 8 8 e 8 Cn <br /> NOTE: A preliminary site inspection must be made and site approval granted On all structures InvOlvmg Sanitary foci rtieS <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 bing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the in( rmation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval oft e Zoning Adm inistratol. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE NND APPROVED. <br />