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Burnett County Office of Zoning Administr for Iv' 7 - <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 nd �2 0 JJ <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulationsof the Stateof Wisconsin. <br /> 7 ..... w <br /> ( w......GW Cad...................................... ...... .a.r.....C. ........... L. .........................:.... . <br /> OWNER (pleaae print) CONTRACTOR o SURVEYOR or AGENT <br /> (Z ITz.....(Q...... F12g� 030y :- E <br /> ..... . . .......................................................................... . <br /> ADDRESS � 1'I•c� 1�iVt(V�N,(.0 �y�, ADDRESS I `P�; <br /> Iw1s I�Jrx�m;..uCm..m��... . ............................................................................ ...... -Q o r <br /> ADDRESS }...........:......... ADDRESS K <br /> PHONE................................................................................ .PHONE...................................................................... .... !0( <br /> O <br /> P�BER WELL DRILLER <br /> ........................................................................................... ...ADD..RES... . E-S-S-.................. <br /> -. <br /> ADDRESS m G) <br /> n < :O <br /> ....... <br /> ........................................................................................... ..P. .. <br /> H..ON....E.......................................... ....................... ...... ? N <br /> PHONE :14v, . <br /> Z rQa <br /> DESCRIPTION4. SanitaryFacilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms ..... Q c <br /> New Building ... Type of Construction: No. Bedrooms �..... <br /> : <br /> Addition ,,,K,,, ,,,,,,SZ✓Q,,,WA�l................... Septic Tank Size Gals. .TC) <br /> Sanitary ...X.... Size .....IQ..... ft. x ....I.y...... ft. .. ....... . <br /> tl i i <br /> Filling/Grading .......... Height........... Stories ....I,,.,,,,,., 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ....................................... ............. <br /> Mobile Home Slope ....................... <br /> .......... . '• ? r <br /> ^ <br /> Perc. Rate ...............,. ....... ....... ? <br /> Privy .......... 3. Use (describe exactly 1 -famil <br /> Well .......... home,garage, motel,a Dry Well ....Seepage Trench z <br /> T <br /> '1 <br /> Subdivialon .......... .................................................... .. ....... o i <br /> Camping Unit Privy .. ...... : ' <br /> Seepage Bed x,�c� -I <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fiji. A. : 1n c"- <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at CD <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> ig <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ___________________________________________________________________ 1- <br /> 5. Lot Size: / Fig. A. 6. Location: ?T ' <br /> 1 'YI <br /> ................ ft. x ............. ft. - .........1:�:. - ..y..... ..................................... ..................... ........ <br /> AV <br /> x 'r_� o <br /> �) o 0 <br /> IL iJ 7A <br /> LAD <br /> ✓fir/ m .._ �.x.Q� <br /> Z'. :Z <br /> O <br /> p <br /> �L, l� <br /> S\A <br /> m �a�c � nm nny <br /> ow : o m o <br /> o'wo D ' -t <br /> uta Na ' <br /> o c m <br /> » = ' O <br /> rai,,-..... . ............................. ..... m <br /> of O nor or Agent Date e <br /> Remarks '.-.:...//........... <br /> .................................................................................................................................................................................. ..... <br /> ' o <br /> .............................. ................................... <br /> .............. <br /> mInsp . � <br /> ection Date .. f.v.. ............7.. Z.. � .......... c <br /> istLL� <br /> omr' <br /> 8 8 8 0590 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has bee 1 issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />