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% X <br /> Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c [F O <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> 1J1R. & 4...... 00111 'A.k ... ...............fY1 .... . ........ ............................ N ° <br /> OWNER (please printf, <br /> Col or SURVEYOR or AGENT a — <br /> ..... . ...... '.11!AaX... Pd..' d <br /> ....................... <br /> ADDRESS <br /> �i !9N.TS.?3GCk......... <br /> (tsS G...S.�& ............................................................................................ <br /> y p <br /> ADDRESS ADDRESS <br /> ................b's��.1.=....�', r ............................... ............................................................................................ n <br /> PHONE PHONE <br /> .......... <br /> ........................................................................................... .WEL.......L ......LLE.. R............................................................... <br /> PLUMBER ...DRI <br /> . . .. <br /> O <br /> ADDRESS ADD... ..RE.SS <br /> o <br /> < Q9 <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building .,,y,. Type of Construction: No. Bedrooms .......... i <br /> Addition mA,S'� R (/J Q,Q, .,. Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ...Af1 r7..... ft. x .f6.0..... Ft. .......... <br /> Filling/Grading g 4a. Absorption Field Site: <br /> ......... Hei ht............. Stories ..TC.QS3... <br /> Moving .......... Area ...................................... .... Soil Type .................................... <br /> .r <br /> :p o <br /> Mobile Home Slope .......................................... <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... I ;o ; y <br /> Subdivision Seepage Trench ..........} .l.......................... Privy ..........CamPing Unit .......... Seepage Bed ....... /fV.. S .. ............•.. :Z <br /> i�.�.. <br /> i <br /> --------------------------- 6i -------------------------------- n <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- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING A� <br /> N 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. � —' <br /> ---------------------------------------------------------------------- o <br /> 5, of Size: Fig. A. 6. Location: ��J <br /> -3o�...... ft. x ..3.<f5? ft. — ...�'1U..Q,a. .......... 5Q.ft. fi ' <br /> �j <br /> N (1 0 <br /> o p � <br /> 3 <br /> �e A �/�l She< 5; '_ it <br /> -tfs <br /> z, <br /> r c. <br /> cou <br /> r Z <br /> � o <br /> €°G <br /> j ee erm I, # L4 6 3 / Sro / �g iu +w+y �ie�s�tev. . <br /> 11 7J Nr � v+ M <br /> P F <br /> `' so <br /> /v 0 I NSI w A-Ter pressa,� 5� S4-ems•.• Iglu, A-f 7A,3 the- -IT o $ v-,. `° <br /> w� p <br /> a�ut c�.L.Y......... ..... . ......... ...... ....4f .....gt3...... D <br /> 0 <br /> Signature of Owner or Agelh ate :Oi'O C <br /> X <br /> Remarks ......................................................................................................................................................................... m m <br /> � E O <br /> ........................................................................................................... .. .............y. <br /> '.Z� . . n. .... ...............r ..................... <br /> : 81 <br /> ..................Inspection Date ....................................... . ....t...... ... <br /> on <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 if 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 Adm inistretoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />