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Burnett County Office of Zoning Administ gator � 9 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < N <br /> shown herein. The undersigned agrees that all work shall he done in accordance with the requirements of the Burnett County Lad Use m G <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wls onsin. <br /> 3a <br /> , o <br /> . ..................................... .................................................................................. ......... N _ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .....s 9..wEs .......5............ .e.............. .......... . . . <br /> ADDRE S p ADDRESS <br /> ../1..��'/ . ..I-AILS. 5`/..O/.7............................................................................. ..I...... <br /> ADDRESS ADDRESS g <br /> ........................................................................................... .................................................................................. ......... ' <br /> �..V....���//..''....�..�S�_(v�.S,�!.f(.............. PHONEOPPHL �E ....................................................................... <br /> %.. ..e. ............................................................................. ............... :%Q <br /> ADDRESS t ADDRESSi m o <br /> �v ..-.5 655........................................ -......................................................................................... <br /> PHONE PHONE Z � <br /> DESCRIPTION 4. Sanitary Facilities: / ° o ° 1 <br /> 1. Work: 10 <br /> 2. New Building Details No. Bathrooms 0 <br /> New Building ,,,,,,,,,. Type of Construction: No. Bedrooms .. m <br /> Addition L ........ ...... Septic Tank Size Gals. Q.. '� < <br /> Sanitary .n"... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading ........,, Height............. Stories ............... 4a. Absorption Field Site:Q <br /> .............. Soil Type ......��. . .��.. ..... .......... o <br /> Moving .......... Area ........................... . k' <br /> Mobile Home Slope .............I.t..... .......... -* <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate ...... ..�.�..... .......... :y <br /> Well .......... home,garage, motel, etc.)� Dry Well .......... ;2 <br /> Subdivision .......... / fes/ ��y (/6 4e Seepage Trench .......... L'U <br /> Privy <br /> Camping Unit ........ <br /> .................................................... _ Seepage Bed <br /> __ �Z �' ..��..... <br /> Location of proposed structures and existing structures, well,sewage systems, roads, etc., should be sketched in Fig. A. Inc;u le road G � <br /> setback, side and back yard dimension and location and setback from all bodies of water. It property is located at a hiyhw-y inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING n < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---_--_.---------------------------------------------------------- --- u <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x .............. ft. — ............................... sq. ft. ...... ........... r m <br /> sE� �Tr�cEO PANS <br /> o <br /> � F <br /> o <br /> o <br /> Z7Nr � � .ym Z <br /> to <br /> N LI:. m D <br /> o - m <br /> 0 o o n 70 <br /> o <br /> v� — <br /> o -R <br /> Ing <br /> li o C <br /> Signature of O net or Agent Date — <br /> p <br /> Remarks�.T-4 7Jf�f`. _rt : : : : : : : M <br /> ......................................................................................................................................................................... <br /> : <br /> e» <br /> " ...................................... . ...... .......... 2� ..1 ....... fl <br /> . <br /> I <br /> g Q o o N0 <br /> rrr <br /> Inspection Date ...... '...... mZn9ooo � <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 percolatio I test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any pl ini or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the formation conveyed here <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of he Zoning Acbn inistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />