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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 < � ipp <br /> :� <br /> shown herein_ The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use � N C � <br /> Ordinance, Sanitation Cod,a d with Y <br /> all other applicable Count Ordinances and the laws and regulations of the State of Wisconsin_ a <br /> L {- / <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT , a — <br /> .. f.. ............ .ly'!i..4 . .....A,......... .............................. <br /> ADDRESS ADDRESS <br /> Hl'L/Q. .5:.......✓tal..� <br /> ..................s '.�".Y....... ........ . ................................................................................. <br /> ADDRESS ADDRESS <br /> PHO PHONE i .0 `T <br /> G.. � .................. . ........... .. . ......................................................................... <br /> ..1.k.� ....................................... v <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... . ......................................................................................... O :\ <br /> ADDRESS A..DDRESS a-1 <br /> n o <br /> PHONE PHONE <br /> DESCRIPTION 0 <br /> 4, Sanitary Facilities: o ° 'ZVI <br /> i. Work: 2. New BuildingDetails No. Bathrooms 0 <br /> New Building X,. Type of Contruction: No. Bedrooms .st?...... '� <br /> Addition ,„ ., ,FY'A vtM, ?, Septic Tank Size Gals. .......... <br /> .... ..... .... ..... ......... <br /> Sanitary ... ... $IZe .... ..y... ft. % ....y. .. ft. <br /> Filling/Grading .......... Height Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area f. ..C..`... .4.!... <... Soil Type .................................... • '. .o . <br /> Mobile Home Slope .......................................... .. <br /> Privy .......... 3. Use (describe exactly, -family - Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc. Dry Well .......... <br /> Subdivision ......... Seepage Trench .......... � I <br /> Camping Unit .......... .................................................... Privy Vp <br /> .................................................... Seepage Bed /-y.. <br /> 1-9 <br /> ----------------- ------ ----—__----__---_—_-- --_—___ —_---------- —_._-- <br /> Location of proposed structures and existing structures, well, sewage systems, mads etc., should be sketched in Fig. A. Inc nde road <br /> G Cf 1 <br /> setback side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- 9j �q a <br /> section, show the intersecurg highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> TSTRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS o' , <br /> ---__-----___---------------------------------------------._..__.__------__-- - O <br /> 5. Lot Size: I/,, Fig. A. 6. Location: (Aj n <br /> ................ ft. x .............. ft. . .... W_� ('4Ch.. s4.ft. <br /> r <br /> be <br /> 1 <br /> N <br /> o <br /> 'A y` <br /> � 7 z <br /> 0 <br /> naS a <br /> A � <br /> V r M y W Z <br /> C d j C N <br /> m N�- w a to <br /> o C: 0 D a m <br /> Z O O n � 77 <br /> (O sq <br /> 3� o <br /> �E p <br /> Signature of/Ow/n/e or Agent Date �X <br /> Remarks .L: ..!1..,.. G:...`':. `. .�r--r..'........................................................................................._.......................... T mm <br /> fl <br /> u <br /> Inspection Date E/:'..(..U.:� ........ .... .. :.�h..7..7G�Y!V�.f.- .......................... <br /> on <br /> Zoning Administrator : 0 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary tacilitius <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test most 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 it misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not He made without approval of the Zoning Adm inistratol. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />