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Burnett County Office of Zoning Administrator o 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 H �. <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 /> Ordinance, Sanitation Code, and�jwith all other applicable County Ordinances and the laws and regulations of the State of Wiscbnsin_ 3 0- <br /> G�.C?... .er........�.t.....l�lf..^..Gkt�n4Zl^..f' ............... ............................................................................................ v� � \ O <br /> OWNER 1 ease print) CONTRACTOR or SURVEYOR or AGENT <br /> '//Q.. . . ... ................ ...........:(�.!... . ......... ................................................................................... ........ d <br /> ` /�/� ADDRESS <br /> 3./. .r7..r,�.?.i..:...�`.�.S..i�., ..�............ . ............................................................................ <br /> // <br /> ADDRESS ADDRESS <br /> ....V'C4 .-. ....................................... ............................................................................................ <br /> PHONE PHONE \ <br /> ........................................................................................... .WE.. D. ..LL.......RI........ ............................................................'i........ <br /> PLUMBER LLER.. <br /> 'A' G) <br /> p ; G) <br /> 0 0 <br /> ........................................................................................... ...................................................................................'r........ 3 5 <br /> PHONE PHONE F Z H <br /> DESCRIPTION 4. Sanitary Facilities: m o 0 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••�••••� fi i o 0�� <br /> New Building <br /> Addition .�— •" Type of Construction: <br /> No. Bedrooms � Ta '.fw <br /> : » <br /> be O Septic Tank Size Gals. ......... » <br /> Sanitary „......„ Size ..... ft. xA.. - <br /> ft. .. ...... <br /> Filling/Grading .,..,.,,.. Height............. Stories .�......... 4a. Absorption Field Site: <br /> Moving .......... Area ..................... . Soil Type .................................... <br /> . .................... ,p r <br /> 0 <br /> Mobile Home Slope "y » <br /> .......................................... v <br /> Privy ....,..,., 1 Use (describe exactly, 1 -family Pe Well vl <br /> Well .......... home,garage, motel, etc.) <br /> Subdivision `` Seepage Trench ......... <br /> Camping Unit .......... �................................ Prlv ......... C <br /> .................... <br /> Seepage Bed <br /> ......... <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc., should be sketched in Fig. A. Include road Q e <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property is located at a highway, inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. pr <br /> i. ft. x .... .. q __—L____ ___________L <br /> 5. Lot Size: ........... ... s, W. Izsw <br /> ----------- <br /> Fig. A. 6. Location: <br /> �.a�C1, ft. - s ft. F` ,IIS......Gl....1..3t........�..�. ��........1......... <br /> m <br /> h� cv <br /> -+ <br /> j oo a <br /> a 71 <br /> NO"Iri✓K./ :O <br /> PA'( <br /> ' <br /> I-.a.�,i ` 7.5- i <br /> 7] N r na N W Z <br /> m a a = n <br /> a' cNn <' y m <br /> m m <br /> .0 oo' a ; <br /> 0 <br /> E» » <br /> t�........Ike 14... s� J o p <br /> Igna ure of net or Agent Dat X <br /> Remarks <br /> T m <br /> ...... Oi <br /> ....................................................................................................... ...... ....`................................... <br /> ............ <br /> Inspection Date ....................................... L�'�!'t4?• % rJ U N 'o o m <br /> ................9..... .... <br /> Zoning A ministrato}�f : . 8 8 8 8 8 8 to <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 he 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 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 Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />