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Burnett County Office of Zoning Administrator all - 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 g <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as w M <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. 3 <br /> tJL oA) a i <br /> UA��.n.....C.... ....NIAY....M,...l.A..................... . O �aF......H...�►�MrR....................................... N <br /> . . . . .. . . . . . .. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a g; <br /> ..................... <br /> ADDRESS ADDRESS <br /> ........................... S/2EN WS <br /> ADDRESS ADDRESS <br /> 6tz1. ..Y..-63 ........................................... ............ � <br /> PHONE PHONE :4� <br /> /Q, l(oPKiNS �c1 <br /> .......... <br /> ............... ............................................................ 'W"'E...L.L D......R.I..LLER................................................................. <br /> PLUMBER W ' <br /> wr3sTc� � wy <br /> ......................................... ............................................................................................ <br /> ADDRESS ADDRESS <br /> . 0o <br /> ...................... < <br /> . . .............................................. ............................................................................................ <br /> [ <br /> PHONE PHONE Z <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: 0 o 0 <br /> 1. Work: No. Bathrooms ' <br /> 2. New Building Details .......... o <br /> New BuildingNo. Bedrooms �. .. •� <br /> ....... Type of Construction: <br /> f. ...... 1.0? P <br /> • •• ; <br /> Addition p••FRgw- Septic Tank Size Gals. .7a.Q. » <br /> ... .. .... ............... .. <br /> Sanitary .......... Size .....1.Q.... ft. x ..... ft. .... ..... .� <br /> 4a. Absorption Field Site: i ' <br /> Filling/Grading .......... Height............. Stories ....I.......... p „ c, ' <br /> Moving .......... Area ........................................... Soil Type ...........g.4..... ...T....!.u..... <br /> Mobile Home .......... Slope .................. f .. <br /> ............ 4A) F <br /> Privy ,,,,,,,,,, 3. Use (describe exactly, 1 -family Pere. Rate .......I... .lM.. y... <br /> n 5l <br /> Well home,garage, motel, etc.) Dry Well R : o <br /> Subdivision .......... SEI}SD NA 1-- VhC.+T t-A/ Seepage Trench .......... <br /> ................ .................I................. <br /> Camping Unit .......... FAW.Ll Privy .......... <br /> ......... I..:. ............................... <br /> ... <br /> • • Seepage Bed _C <br /> ----------------------------�P '�''"` ---------------------------- =__ <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> ZF <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- U a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING N < <br /> vl It <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS-------------------------------------------------------------- <br /> . O <br /> 0 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> .....I��... ft. x .... ft. — ............................... sq. ft. ..1.A.f......2:Q.....L.ARIZA094rc......S..V..Q�/V/5(ssr1� <br /> Sr SIDE V/01-4 L4KF <br /> oLA <br /> LA cE <br /> o <br /> 3g //l/57'ALG �/•�/ <br /> o <br /> IL <br /> 8r n <br /> 38' I 30 <br /> 3o' EIuSTrN6 HoD1E o <br /> d <br /> m <br /> r 1 p�GI I,N Pp POSED <br /> IO � RpoM' � ADD/Trod <br /> �. L. . 1 0Z <br /> T cQ � < m � cm <br /> m �6 4 = n F <br /> �J Z Oo D <br /> 21np <br /> O aro 3 <br /> Hi <br /> c _ moo <br /> ....... . ...... . . ........................ . <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks . ..................................................................../.................................................................................................. m : rn <br /> rn <br /> �e..... /3 �r sLf�t"�9t C..<c ,OPl. -._....�................................................ f» i <br /> ............. .. .. ............................ ... .. .. ... .�........................�.... .... <br /> II <br /> q H T <br /> Inspection Date ....................................... / " . � LCL....�`.. ............. E Oi � o m <br /> Zoning Admin rotor 8 8 8 8 8 rn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facili ies <br /> before construction can begin. In the case of sewerage disposal systerns, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do riot 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 if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not tie made without approval of the Zoning Adm Inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />