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Burnett County Office of Zoning Administrator M 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as ,n :n <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> 104ARD EBERT -�'�ny r3'OVA = d S o <br /> .... ...........6ARRY...n!.fF2 .r�s7GrN.f3: ........................... ......R.1 cu..ARo......e.3 ............................. M <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .... .3.<1...�I. 11R.�1.....ST ........................ ...... ..3 ...H11R..Y....S� ............................................ d 11 <br /> ADDRESS ADDRESS !� <br /> .......DP-4/.5-I !A.(2....... .1.........tz3.11%.............. ......(,7.ry.5.m4n.......!'M5........ yj <br /> ADDRESS ADDRESS <br /> 41.4 .........4b.ra....... 1.49-................................... p <br /> ................................................................................ <br /> PHONE PHONE : <br /> 1f .1.4 ...-....�..l,..ra.. 14 4-............................ ............................................................................................ u <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... <br /> ..oD.......N.aP151!1. ..................................... <br /> ADDRESS ADDRESS ;� n o <br /> ............. . . ...................................................................... ............................................................................................ O N <br /> PHONE PHONE Z m ;� <br /> DESCRIPTION 4. Sanitary Facilities: I ° o ° y, <br /> h <br /> Batrooms <br /> 1. Work: 2. New Building Details No. <br /> New Building Type of Conytruction: No. Bedrooms ..�..... Q� o 't <br /> Addition ,,, , .,1.0,,,` ,..C` ,•••• Septic Tank Size Gals. ..........g :p pa <br /> Sanitary X;' $ize .. .�..... ft. X ......7..6... ft. <br /> ruling/Grading •.•••„••• Height,.y......... Stories ........ ..� 4a. Absorption Field Sile: / wa <br /> Moving .......... Area ..]{.(t.3.f° ...../o..S.��. ... Soil Type ............5...r%... .......... ? a m iW <br /> Slope .......................................... :W o r:A <br /> Mobile Home .......... a oX <br /> Privy .......... 3. Use (describe exactly, -famil Perc. Rate ................................... f <br /> Well home,garage, motel, etc. Dry Well ........., ^ ^ Q..... Seepage Seepage Trench .......... wE <br /> Subdivision .......... .................................................... <br /> _'' II <br /> Camping Unit .......... .................................................... Privy <br /> Seepage Bed }---------------------------------------------------------------------- <br /> - <br /> J� <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 — <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O <br /> ----------------------- -------- - ................... . <br /> 5. Lot Size: Fig. A. 6. Location: <br /> .�............. ft. x .............. ft. — s ft. <br /> vv ............................... <br /> N o <br /> o <br /> ^1 46 <br /> W D <br /> Z <br /> r <br /> J r < m <br /> <° N L1 6 •< = iu p m <br /> -o (n < C <br /> m D <br /> n <br /> Z o o <br /> ► 8X36 3 <br /> 4�\ �n <br /> ca <br /> Wg m <br /> ....... .......7.:7717n.15...... €R s c <br /> Signature of Owner or Agent Date <br /> Remarks ..1 `!Pz.. .. ::.3. .. ..... ........ .....5%'2?w.. yc%.. � .... T x m <br /> .a . Q�. . ... ¢per ti:...�.o... . rrC. ....... ....:... ...................... <br /> ......Cir.,�.�:....:.......y �.....:��. . . . . . �, <br /> .............. . <br /> Inspection Date .......................................—..� �2vx1,0� .... ....:..� ................. o. H N m m <br /> ....:.... g .....✓ ynrnou� o <br /> Zoning Adm nistrator c 8 8 8 8 8 8 C4 <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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> j'w -* -733 <br />