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Burnett County Office of Zoning Administrator c Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3' 0 1 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < m ?� <br /> shown herein. The undersigned agrees that all work shall he done in accordance with the requirements of the Burnett County Land Use ;F <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n i� <br /> ISE L L ,V 11R8/414A1 - %Sp£'- 3,vy /J�I l ie i C 0 <br /> ............. <br /> OWNER (please print) CDNTRACTOR or SURVEYOR or AGENT 0 <br /> .. . ......l.:.p...! .... RNway......... ! ....... _ . <br /> ....................................................................................... ... <br /> ADDRESS ADDRESS <br /> .. . . . ..sr..... .P..4.v�.....-`?.�✓... si.... ........ . . . . ; <br /> ............................................................................ <br /> ADDRESS ADDRESS <br /> ....................................... ............................................................................................ <br /> PHONE PHONE <br /> PLUMBER............................................................................ WELL DRILLE..R.................................................................... >� <br /> .................. .................. p <br /> ADDRESS ADDRESS o <br /> 0 < <br /> ........................................................................................... ... ................................................................................... o <br /> PHONE PHONE...... Z o r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details • o ?� <br /> New BuildingNo. Bedrooms .......... a <br /> ..,x.,.. Type of Con ruction: <br /> Addition G/yR ..E Septic Tank Size Gals. .......... p < <br /> Sanitary .......... Size ...... ft. x .............. ft. .......... <br /> Fillingt Grading .......... Hiiight............. Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area ........................................... <br /> Soil Type .................................... r <br /> o <br /> Mobile Home .......... Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... i <br /> Well ..•••„••, home,garage, motel, etc.) Dry Well .......... pp <br /> Subdivision ........., <br /> 6 gyjgGE Seepage Trench .......... <br /> Camping Unit .......... Privy .......... <br /> .................................................... <br /> Seepage Bed .......... (� i <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be 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. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING = <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> is o <br /> ---------------------------------------------------------------------- <br /> 1 <br /> 5. Lot Size: S-.7 Fig. A. 6. Locatio <br /> ....., .�.I. ft. x 3.Y6... ft. — ........ ......./geRQ. sq.ft. .. �........... ........ ...E,5 tQ. ............, O i E <br /> A, :....... BAY . . Q.... ?` <br /> Co <br /> O <br /> /✓��7�_ P LAM LAR KE p9'/1/E IN 0 <br /> 3 <br /> �os� o UI <br /> / -F <br /> 48' ,ZSD� FkOMlia <br /> a <br /> a o <br /> r <br /> y <br /> z o o' n 70 <br /> 0 0 a 3 <br /> F» - <br /> Signature of Owner or Agent Date <br /> X 77 <br /> Remarks ......................................................................................................................................................................... r m <br /> v <br /> Ve <br /> ........................................................................................................................................................................................ II <br /> ....................................................................................................... .... .......................................................................... i 1 <br /> T <br /> ° �' Nq1Jv <br /> mInspection Date ....................................... <br /> ZoningAdmin stra.tor icJ <br /> 8 8 8 8 8 8 Vl <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 revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not tie made without approval of the Zoning Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />