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1 .iCr�J7G E' 79 t� . <br />Btir4tt County Office of Zoning Administrator ? CD (( o <br />�tIOATION 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 * i0 <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 <br />Drdinanre, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 CL <br />.(�.. ' .�.�..........1/�.��.1..!v <` <br />p <br />............ ..................................................................................... <br />_ a <br />;° 3 <br />OWNE (please print) CONTRACTOR or SURVEYOR or AGENT o. <br />0[� m <br />A.�..........!c.1. S?...4..h .................................................................................................................... <br />ADDRESS ADDRESS M <br />..`. �..:..... .. �.A..Q1V�...... .. %..�v........................................................................................................ <br />ADDRESS ! ADDRESS <br />'HONE <br />......................... <br />'LUMBER <br />AD...............................4............................................... <br />4DDRESS <br />.................................4L'j;.......................................... <br />'HONE !r 3 j' -- 2 G,L �' --] , <br />DESCRIPTION <br />Work: <br />New Building ......... <br />Addition ,••„•,,, <br />Sanitary ,•i� <br />.......................................................................................... <br />PHONE :ice I <br />.................................................................................... <br />WELL DRILLER <br />ADDRESS :Cly\ C o <br />0 < <br />........................................................................................Z O r: <br />PHONE 3 <br />2. New Building Details <br />Type of Construction: <br />.................................................... <br />Size .............. ft. x .............. ft. <br />4. Sanitary Facilities: <br />No. Bathrooms <br />No. Bedrooms <br />Septic Tank Size Gals. <br />0 0 0 <br />S <br />.......... <br />Filling/Grading .......... Hei ht .............Stories ............... <br />4a. Absorption Field Site: <br />Soil Type <br />C C d I <br />CDoa <br />Moving .......... Area ........................................... <br />................................... <br />- <br />W f <br />=—'a <br />Mobile Home........ <br />Privy 3. Use (describe exactly, 1 -family <br />Slope .................... I..................... <br />Perc. Rate ••••••••••••••••••••••••••••••••••• <br />J: <br />,,..,,,.,, <br />Well .......... home, garage, motel, etc.) <br />Dry Well ..........No <br />Subdivision.......... <br />Seepage Trench .......... <br />O . . <br />.................................................... <br />Camping Unit .............................................................. <br />Privy ••"•"”' <br />CD <br />Seepage Bed .......... <br />RJ <br />---------------------------------------------------------------------- <br />o <br />C <br />Location of proposed structures and existing structures well, sewage systems, roads etc., should <br />be sketched in Fig. A. Include road <br />setback, side and back yard dimension and location and setback from all bodies of water. <br />If property is located at a highway inter- <br />section, show the intersecting highways and the setbacks required along them and at the intersection. <br />CLEARLY LABEL EXISTING <br />b: <br />IO. <br />STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br />o40 <br />0 <br />01 MM <br />—_____________________________________ <br />5. Lot Size: Fig. A. 6. Location: <br />................ ft. x .............. ft.. ............................... sq. ft................................................................................ <br />4w... ............................. ..... �Z?../... �.. <br />)igna ure of nernnor Agent Date <br />3emarks.......?.. ��a..Y..f.................................................................................................................................. <br />..........l...-................................................................................................................................... <br />............................��...'.................................................................................. ..,.G.......................................................... <br />nspection Date ...1.....f ....... �?.. .:.... .4../iJ�Q../...:..... .......�inistrator <br />...................... <br />Zoning Ad k <br />0 <br />N <br />C <br />Q' <br />O- <br />N <br />0 <br />3 <br />T <br />Z <br />O <br />W- <br />91 <br />n <br />0 <br />3 <br />'Kk�A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br />.onstruction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br />ation before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br />ermit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br />to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br />STEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />DISTRIBt <br />-)ILHR-SBL <br />C C d I <br />CDoa <br />CD (DD <br />a- a < <br />m fAan� <br />W f <br />=—'a <br />03w <br />C MV <br />in' ID <br />D a m <br />Z 00 <br />O 3 <br />a D] <br />O . . <br />. . <br />CD <br />o <br />C <br />X <br />CO :o <br />Co <br />b: <br />IO. <br />: <br />T <br />o40 <br />0 <br />01 MM <br />• <br />- 888888N <br />'Kk�A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br />.onstruction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br />ation before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br />ermit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br />to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br />STEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />DISTRIBt <br />-)ILHR-SBL <br />