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Burnett County Office of Zoning Administratoro <br /> APPLICATION 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 < m -^ tr['� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m V <br /> Ordinance, Sanitation Code, and with all other applicable Count Ordinances and the and regulations State of Wiscpnsin. 3 a <br /> AJ ...........Y <br /> .((// .�?.ftnitt .Idv!c !............. . . ......................................... N o <br /> OW ER (plEase print) CONTRACTOR or SURVEYOR or AGENT a <br /> �J(V R m <br /> ..(.Y.XL.tf.....I....stii .P....Xal.`:.......... .............................. ............................................................................................ <br /> ADDRESS ADDRESS i <br /> .......... .......-...................... ................ A� <br /> ADDRESS / u ADDRESS <br /> .........L.!................................. ... . . .................................................................................... <br /> PHONE •� yb a a y J SN°j, PHONE <br /> .......... <br /> ............................................................................ .................................................................................. <br /> PLUMBER WELL DRILLER ELS <br /> ADDRESS ADDRESS n o <br /> ........................................................................................... ............................................................................................ � o <br /> 6 " <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° iG <br /> 1. Work: 2. New Building Details No. Bathrooms ;.�.,..... o j <br /> New Building Type of Construction: No. Bedrooms 3.... <br /> Addition ....... .. ...,.,.,,,q „jj^Q,`.!�`, ! ,,,,,, Septic Tank Size Gals. ;......... i <br /> Sanitary .......... Size ...pv..ip... ft. x ..c7�..tr'?.. ft. <br /> Fil ling l Grading .......... Height............. Stories ............... 4a. Absorption Field Site: i Q� <br /> Moving .......... AreaSoil Type ..�.-.�G...rl. �. z o <br /> ......................................... . <br /> Mobile Home <br /> Privy ly, family_. Do WB pe ............................L.' <br /> ....... .. 3. Use (describe exact - / Seepage Trench <br /> „ ., garage, - y ^"" " <br /> Well home, motel, etc. <br /> Subdivision """"" :r <br /> CampingUnit .......... .................................................... U <br /> Seepage Bed ' <br /> -------------- ------------- ------------ ---- -----_—_.--_ I do <br /> Location of proposed structures and exrsting structures, Weil, sewage systems, roads, etc., should be sketched in Fig. A. Incde road ? <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property Is located at a highway infer- <br /> section, show the intersecting highways and the setbacks required along them and at the 'mtersect'ron. CLEARLY LABEL EXISTING �`� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �1 o <br /> -----------------------___---_.—__._-----_---_--_------------------_—___—_— <br /> r 1 <br /> 5. Lot Size: Fig. A. 6. Location: d <br /> ....... ....... ft. x .............. ft. — ...__...._.................. sq.ft. .........-fF' i <br /> _ E <br /> I � , <br /> aea <br /> T � � <br /> '+ <br /> N N <br /> �..,. r <br /> f o <br /> T <br /> -ex�sTn <br /> Id, "q <br /> r w m <br /> `' ? �3 _. T6 � �c lit kL � W,I <br /> so <br /> 0. <br /> on <br /> _ o0. : <br /> Zoo . <br /> do <br /> 0. <br /> .. .IY / 35/ 9 ne <br /> Ig ture of wner or Agent Z /Date X <br /> Remarks .........r!!U�e. .../,7/'P,ol... ...:�'.P.....`Yi��aG/ .:~... .Sl��. . ..I s.....0^- .�"'._..7.r. .v..�....... ? m <br /> 6 e sec—dcW . .^ I t b <br /> f........�re0. ................................I........ .. .......t.�!.. ........a %s................ <br /> .S..Q ......7 ..... eros<�. .�........... <br /> II <br /> ............. . <br /> �................... . .............. <br /> Inspection Date ....................................... Ci '�.".�........ ............ .. . ........:....... <br /> m <br /> Zonin Admini� o o o N <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 plunnhing or start any build- <br /> ing until a permit has been Issued. A permit may be revoked if misrepresentation of arty 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 Administratot_ <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />