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Y� � �-J7 7✓r'i'''7''! 2� _ <br />Burn/eft �ounYy Office of Zoning Administrator v CD 0 0 <br />APPLICATION FOR SANITARY — LAND USE -- BUILDING PERMIT v <br />;+ o <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N — U, <br />shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD <br />-0c �� <br />Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br />a <br />Floyd E. Wages - Y o <br />............................................................................................ y <br />OWNER (please print) CD <br />CONTRACTOR or SURVEYOR or AGENT a v <br />422 S. 2nd Ave. Q <br />.................................................................................................................... <br />ADDRESS ADDRESS <br />Canton, IL 61520 t° <br />.......... ¢ <br />ADDRESS ADDRESS <br />:\ itrJ <br />309-647-3952 <br />PHONE ................................. �,� <br />........................................................................... <br />PHONE :\ <br />Donald Daniels <br />......................... <br />PLUMBER WELL DRILLER <br />BoxW Siren A.. WI ..... 54$7.2 54M ........................... ............................................................................................ b o <br />ADDRESS ADDRESS m G7 <br />aC h o <br />...7. 1.543-233.3............................................................ <br />............ : <br />PHONE PHONE ZN r <br />DESCRIPTION 4. Sanitary Facilities: ° o ° <br />1. Work: No. Bathrooms ...1..... T <br />2. New Building Details @I� o <br />New Building Type of Construction: No. Bedrooms ...2..... <br />Addition Mobile home Septic Tank Size Gals. .750... .� W <br />Sanitary ..... X... Size .............. ft. x .............. ft. .......... <br />Filling .......... Height ............. Stories ............... 4a. Absorption Field Site: h <br />Moving .......... Area Soil Type .......................9aAd..... :� � <br />0 <br />Grading Slope ......................... leval..... <br />Mobile Home ..... 3. Use (describe exact) 1 - family <br />�... Y, Y Pev .Rate2......... � in <br />Privy •......... home, garage, motel, etc.) Dr Well .......... -1 <br />Well Seepage Trench 0 <br />...Sit<rgle•-f'ami.l.y..M.?H.......... Priv �o <br />Subdivision y •• •••••• <br />............................................................. <br />Seepage Bed X..... �; <br />------------------ -- - - ----------------------------- `� :z <br />Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road ' C NIS <br />setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- pq`4 0 <br />section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING l� �`—• <br />STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS.AX <br />"1 o' <br />---------------------------------------------------------------------- <br />5. Lot Size: Fig.A. 6. Location: <br />Q.CiiJ aeblzl' (, SIAI1SS 'kb w• ba Fl- <br />............ ft. x .............. ft. - ............................... sq. ft.�........... ��!.........!..'` !. .................. <br />C <br />CD <br />o CCD <br />Do <br />t7 w <br />' m <br />to <br />n o <br />x I 7' <br />CD <br />CD <br />-� <br />n <br />f <br />iv °�v z <br />v CD CD <br />D N Q CL r« <br />C'cn< C. <br />M <br />o <br />�r o —i <br />o <br />M <br />%�............ ..�,�/.�...................... o C <br />Signature f Owner or Ag Dat-" Date: <br />X <br />Remarks .... I / Q <br />Q�e /Ia7'' <br />12..e.....��J...L.Z....... ,5......I.D.S...,r...h.y...%...t!...... ................�......... 5'k�' �; v <br />CD <br />rrF'..... ......... X. .cam.. ..... ..1.. ..t.........1�f.C,......4. '.�..........h�n..,f1'�7 r......�1 .amu. `......... <br />.*-V.�ny........w.... .�1.......Fa.r. e.Y.... .��:u ....../-.��.m....... .............. <br />o: <br />N <br />ocnm <br />Inspection Date ....................................... o o o' o o m <br />Zoning Adminis rator ` 0 0 0 o o 0 <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 />