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Burnett County Office of Zoning Administrator ,� �' z <br /> 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 {{{yyy\ <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use 1 <br /> OWNER ( le se ri on Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 d J, <br /> Ordinance Sanitation <br /> a <br /> m <br /> N R (pl e�se pr i...11.�.b.r..e........ .�h.r..e.n.d,r. <br /> P P nt) CONTRACTOR or SURVEYOR or AGENT m <br /> a m <br /> (./ <br /> .�1..I.... ............................................................................ .ADDRESS............................................................................ �Ust <br /> ADDRESS <br /> . .........� k' <br /> 'ro�. ..tV...........1 /.,..2 ............................................................................................ <br /> Aj)DRESS �' ADDRESS <br /> 5....(..�..��..6.F..1.......^7.i <br /> PHONE /.A....................................... . . ........................................................................................ <br /> PHONE <br /> PLUMBER .WE.....L.L D......R.I...LLE.FI.R.................................................................... <br /> ADDRESS . .......................................................................................... E <br /> ADDRESS c <br /> ........................................................................................... . ........E.................................................................................. <br /> PHONE PHONN <br /> DESCRIPTION 4. Sanitary Facilities: ° o .°r. SD <br /> 1. Work: No. Bathrooms D <br /> y 0 <br /> 2. New Building Details <br /> New building .. Type of Cqnstruction: No. Bedrooms .......... i <br /> AdditionU e+w Septic Tank Size Gals. .......... <br /> .,.....,.. <br /> ..................................... <br /> M . <br /> Sanitary .......... Size .:'.?. ....... `� : ? <br /> Filling/Grading ,,,,,,,,,, Height,/.:'.�r�.y? Stories ...�.......... <br /> 4a. Absorption Field Site: <br /> Moving .... Soil Type .................................... <br /> ...... ........................................... r <br /> Mobile Home .......... Slope ............................ ............. o <br /> ; <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .,,....... <br /> Subdivision Seepage Trench .......... <br /> y <br /> ............................ N <br /> Camping Unit .......... Privy .......... <br /> .......................................I............ <br /> Seepage Bed <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should he sketched In Fig, A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Inter- N _a <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. `1 o <br /> -----------------___----___--___---__---____-- ____---___---_____----_- <br /> 5. Lot Size: _ Fig. A. 6. Location: <br /> 1..'D..�......... ft. x —1.4 J..y ft. . ........ ..... sq. ft. ........................ <br /> as <br /> 0 <br /> o o. <br /> i <br /> y <br /> O �7 <br /> o <br /> n <br /> DJ <br /> i = re <br /> h i <br /> r <br /> 3 y r <br /> � A � M 00 ,- M m m z <br /> �NyC' � �pllUe 4e � 3 � n fp o- �• <br /> 1,eg1) ,�• tD r t 0- C m' m <br /> m a v < ' � '° ``-' m <br /> O -'. y n <br /> — <br /> [ o^. <br /> O <br /> .... .. . ...... ..... .......... `! ��. ..... o c <br /> Signature (h Owner or Agent Date = <br /> _ X JO <br /> Remarks ......................................................................................................................................................................... T m <br /> v <br /> ........................................................................................................................................................................................ <br /> X111 <br /> ...................................................I............. <br /> ............................................... <br /> Inspection Date ................................... .. N0 Lit N o c, o U <br /> T <br /> Zoning inistrator $ $ $ $ c $ <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 revoker) 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 imstratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />