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Burnett County Office of Zoning Administrator d o 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 0 V <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. 3 n <br /> a ` <br /> Jh499E5 (� V kil 0 . 0�C A6 Al £ <br /> ................................. ........... ........................................... ............................................................................................ <br /> OWNER (pleas <br /> e�jint) CONTRACTOR or SURVEYOR or AGENT a <br /> S �jc,............... .. . . <br /> ADDRESS ADDRESS m <br /> a�.1.a.Q.h {.i.M.C,.r..o.��.... ... . ..1.... ..............................................................I............................. <br /> ADDRESS t ADDRESS <br /> . <br /> . .....� ............. . .`�..................... . . . ...................................................................................... <br /> ................ <br /> PHONE PHONE <br /> .......... <br /> ........................................................................................... .......... . <br /> DRI......LLER............................................................. <br /> PLUMBER WELL <br /> _-- <br /> ........................................................................................... ............................................................................................ _. <br /> ADDRESS ADDRESS <br /> ................................................................................ ......................................�.k..lY 4�.�...�N.. cJ <br /> C) <br /> 0 <br /> PHONE PHONE Z r <br /> DESCRIPTION 4, anitar Facl Itl ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .....I.... o � <br /> New BuildingNo. Bedrooms <br /> ......I... Type of Construction: I z <br /> Addition V.. Septic Tank Size Gals. .......... ; "?�� ]� <br /> .... ... ....... .............................. ............. <br /> Sanitary .......... Size ....x.52... ft. x .........!.. ft. ........'. <br /> Filling/Grading .......... Height // <br /> Stories . .�.j-y 4a. Absorption Field Site: <br /> iJ <br /> ..... ....Moving Area Soil Type .................................... r <br /> Mobile Home Slope ............................. ........... <br /> .......... <br /> Privy y, Y Perc. Rate ................................... <br /> 3. Use (describe exact) 1 -Tamil <br /> Well """"" <br /> it <br /> Well ,,........ home,garage, motel, etc.) Dry N <br /> Subdivision ,,,, ���(j fe h Seepage Trench .......... .� <br /> ...................... . <br /> Camping Unit .......... Privy .......... N <br /> ................................................... Seepage Bed .......... <br /> cn <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig A. Include road ch ° <br /> Cr <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter eso n -{ <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> p o <br /> - <br /> -------------------------------------------------- <br /> 5. Lt Size: SFig. A. 6. Location: v <br /> C <br /> ..�..�.g.n.�ft. x ...� ..Y. ft. — .y.. ...4.(7....... sq. A. <br /> ............................................................................... <br /> 300 2,3 Ac-f2&s <br /> 0 6 ' N o. O <br /> o <br /> N <br /> 0 <br /> S- <br /> 0 <br /> ---JN [� <br /> ¢� <br /> QQ�sc�,'r ne�J ° 'SLI o <br /> (J y 3 6' \ d <br /> Ca <br /> J <br /> will ,- � <br /> � (nr vim <br /> n Q < m E. <br /> "O on <' w <br /> m <br /> 0 eo <br /> O <br /> i2oACt _ . <br /> �. ... ... .... .........r.....a . 3'.y ° <br /> m <br /> n; p <br /> Signat of Owner or Agent Date i0 <br /> / // X <br /> R arks ... A.n..!..TA'.le.. ..... . �.Y.... .T��........17.u.f..�r.....�.� . t-f.��:/�'/�lE....C�CJ/�l�/^c� 1 : 0 <br /> 9m - 1. . :.. . .. m <br /> ::J r.. oail4 ....�7. oaf u��.�.., .7-... u:�t.......... .....:-... gl�ag.�.�..7..c�.... .. .....v..... <br /> � II <br /> .... <br /> ........... `p¢E <br /> aInspection Date ....................................... P . o u oam m <br /> soningAmitrator <br /> 8 8 8 8 8 8 ti <br /> NOTE: A preliminary site Inspection must be made and site approval granted on all structures involving sanitary faeilitieS <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 inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />