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Burnett County. - Office of Zoning Administrator of I. o o <br /> I APPLICATION FOR SANITARY — LAND USE —BUILDING PERMIT 3 . <br /> TO THE ZONING ADMINISTRATOR: The undersign ul highly, makes implication for a Permit for the work described and locataf as <br /> shown herein. The undersigned agrees that all work shall bedmna in accordance with the rearpuirements of the Burnett County Land Use is c I <br /> Ordinance, Sanitation Code,and with all offer applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 r a <br /> f f�A.. .�i.c. ea.......1"lo.EL./_ .. ...._...... . .... $. .F................... v o <br /> i — <br /> OWNER IpIrY inti <br /> CONTRACTOR or SURVEYOR or AGENT <br /> t" ................................................................. ............................................................................................ <br /> ADDRESS ADDRESS ' ' - <br /> m Az <br /> V <br /> ... <br /> _..D ✓I3.uk. !.. ..u.�s.:........b:.y�!Tv.... _......._.........._...._...:._ ...... <br /> ..._............................ ........... ..... <br /> ADDRESS' ADDRESS <br /> V Y <br /> PHONE PHONE - <br /> WELL DRt LLER <br /> ...............................:.............:............................:...........:.... ........................................................................................ <br /> ADDRESS ADDRESS - I :r <br /> PHONE ' - PHONE Z' ° r. <br /> DESCRIPTION , h. Sanitary Facilities: ° S ° <br /> 1. Work: 2. New Building Details No.Bathrooms .......... . p! o <br /> New Building � Type o n tract No.Bedrooms. ' ......... (1 - <br /> ...... ,J, j 'fin <br /> Addition - ........./.:" /..(M G.........�.1 Septic Tank Size Gals. : <br /> Sanitary Size .J4....... ft. z _. .7.... it. ........ <br /> Filling .......... Height............. Stories ............... .4a. Absorption Field Site: i <br /> Moving ............. Area . ....... Soil Type ....--.............. . ........ <br /> ....... ......... .. .....:......... <br /> Grading .. i <br /> O <br /> Slope .......... ........................ <br /> Mobile Home .......... .3. Use (describe exactly, 1 family Perc. Rate ........... ....... <br /> Privy, .......... home,garage,motel, etc.) Dry Well .._..__ <br /> Well Seepage Trench .......... <br /> fR: F ::.:::::.:: Privy <br /> Subdivision - --' '` .L <br /> Seepage Bed .......... U <br /> -- --- --------------------------------------------------------'_— p � <br /> Lai of proposed structures andexistiny A eeturys,well sewage systems,roads,red,should be sketched In Fig. A. Include road <br /> setback, side and track yard dimension and location and sorbackdmm all ticdie:of water. If Property Is located at e highway irI <br /> section. show the intersecting highways and the setbacks requireg along them and at the intersection. CLEARLY LABEL EXISTING – <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------- ------------------------------------------------------ <br /> 5. <br /> ------ -------5. Lot Size: , Fi A. - O <br /> �/ g _ <br /> — Ei° <br /> _ I <br /> an <br /> a ; <br /> a o <br /> Ac t v <br /> L: <br /> 0 <br /> o I <br /> i <br /> �I1 <br /> _ 9 on m <br /> so a.�. ° T <br /> to< m n n R <br /> oso <br /> _.Ci ? .� ' z <br /> 2 se <br /> No <br /> N <br /> Co x <br /> �n <br /> Signature of ner or Agen , /I Date - '�— ] <br /> r x n <br /> Remarks ._._............................................................ .......:.._....... L-...... a......, a <br /> .............................................. <br /> .............:................................................... <br /> . s.......................................... ....... ........ .......................................:...f.........:... — <br /> rn <br /> sea <br /> Inspection Dale Zoning Administrator ' 60666 <br /> NOTE: A preliminary site inspection must be meds and'site :grprov;d granted on all structures Involving snnilury far.illtins <br /> before construction can begin. In the case of sewerage disposal systems, I 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 tens, do any Rur,long or smlt any build <br /> -Ing until a permit has Been issued. A permit may be revoked &misrepresent; tion of any of the sirloan anon conveyed here <br /> with s'found to exist_Changes in plans or specifications shell not be nrrule without approval of the Zoning Admrnivrator. 1 <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. I{i <br />