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&-��L--f--" <br /> Burnett County Office of Zoning Administrator o o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 0 <br /> < — <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br /> shown herein, The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> /? ......................... . .......................................................................................... <br /> E) <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT '0 <br /> a <br /> ..... <br /> a A <br /> ADDRESS '�,�r�-- _ ADDRESS <br /> ��....��!.`. (.................CV y �... 1Y?..S a ............................................................................................ <br /> ADDRESS ADDRESS \w\ <br /> ..... <br /> PHO 7^/ PHONE <br /> !f <br /> ©N. . . L.. .i...l...•c.. �.................................. ............................................................................................ <br /> PLUMBER WELL DRILLER \h4 <br /> -.-......................... . .......................................................................................... _ <br /> ADDRESS :'� ;�J <br /> DRESS / 0 o <br /> ADU <br /> ................................... ............. <br /> ........................................................................................... ........E................................. . N <br /> PHONE PHON � <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> v <br /> 1. Work: 2. New Building Details No. Bathrooms .... .. o <br /> New Building .......... Type of Construction: No. Bedrooms .... '0 <br /> .3... Q a <br /> Septic Tank Size Gals. /2.5 <br /> Addition <br /> Sanitary „��., ,. Size .............. ft. x .............. ft. <br /> Eillingf Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Soil Type ...I....... <br /> Moving .......... Area ........................... .......... ............... <br /> ,.. 7'�.�. ..... <br /> r <br /> Mobile Home Slope ................a:7.7r..��G�..�w <br /> Privy Pere. Rate ...................`�.. .......... O <br /> ,,,,.,,,.. 3. Use (describe exactly 1 -family Dry Well w � ' <br /> Well .......... ome garage, motel, etc.) ^-Q <br /> ,,/ Seepage Trench .......... I :\ <br /> Subdivision .......... ...............4. L l.T4:�z ... <br /> Privy .......... <br /> CampingUnit .......... ..................... ......................... .... <br /> Seepage Bed <br /> _— <br /> — — --- <br /> C \ <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc-, should be sketched In Fig. A. Include road r EV � <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property Is located at a highway inter- l� 4 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURLS AND PROPOSED STRUCTURES AND ADDITIONS. O <br /> ______________ ___--____-__--__--- <br /> 5. Lot Size: Fig. A. 6. Locati : p <br /> i <br /> .1��.... ft. x ..��. ft — ........................._.... sq.ft. ......... ��J....!.�[!.!.s7.1... :� ; <br /> 01 <br /> N O. <br /> 3 'qV,r <br /> V <br /> 0 <br /> s <br /> N r9 :pam <br /> 9 <br /> C NNaC� C 00 -0M : <br /> z oo' n 70 <br /> Cg <br /> 0 <br /> / .! pp <br /> na m <br /> Signature of Owner Agent -7 ate X <br /> Remarks ... ....Z�U9.7............................................................................................................ 0 <br /> .'............................................................................................................................. v l <br /> ................................. .. ......................... .. .... ......................................... i� <br /> m _ Nm <br /> Inspection Date . —..°2.Gr..-D. ....... ...: ...�` ...................... o. 8 8 8 8 0 8 y <br /> Zoning Adml Istrator ,G <br /> NOTE: 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 /> ing until a permit has been issued. A permit may be revoked it misrepresentation of any of the information 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 />