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Burnett County Office of Zoning Administrator 0 0 0 <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 < h <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a \p <br /> Ell <br /> .................................. ....... ..................... ...................... ............................................................................................ N <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> R. .T .. . / ................................................................ <br /> ADDRESSADDRESS <br /> ................. a <br /> / 7 <br /> RRaTs �3 u ...w ............... .SC`...... <br /> ADDRESS ADDRESS <br /> Yom\ <br /> PHONE � 9 PHONE ? � <br /> ........................................................................................... .WE.. LL. .......DR....ILLER............................................................................. iO <br /> PLUMBER :\J <br /> � i <br /> ADDRESS ADDRESS <br /> n O <br /> ........................................................................................... ....... ................................................................................... O .i <br /> PHONE PHONE.. Z N <br /> DESCRIPTION 4. Sanitary Facilities: °or <br /> 1. Work: 2. New Building Details No. Bathroomsv <br /> .......... <br /> New Building X„ Typepf Cory�tructio No. Bedrooms .......... s <br /> Addition ,,,,,. J-a-lr+f�- .t� Septic Tank Size Gals. <br /> .......... 0 i <br /> .......... y� ...... ........... <br /> Sanitary .......... Si ze .. �-Cj.. ...... .......... <br /> ........rt''...ft. x .............. ft. <br /> / 4a. Absorption Field Site: - <br /> Filling/Grading Height.� .`..��torles ............... ? t <br /> Moving 7 .., Soil Type .................................... r <br /> Area ............ ... ..e....... ...... <br /> Mobile Home ° <br /> Slope .......................................... <br /> Privy ..,,,..,,. 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Weil .......... ho ,garag m el, etc.) Dry Well .......... <br /> Subdivision .......... Seepage Trench .......... <br /> ................. .................................. <br /> Camping Unit .......... Privy .......... <br /> .................................................... Seepage Bed <br /> .......... i <br /> Location of proposed structures and existing structures well sewage systems, roads etc.,should be sketched In Fig. A. Include road 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- o- <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. o� <br /> ____________________________________ ________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> .../��..�... ft. x ft. . ...../J P.re........ sq.ft. .................. .....G...C...................-.oc.........�..-.-......-...�..e....... <br /> 0 <br /> L4Ke N1 <br /> Q <br /> 0 o <br /> o b <br /> O o <br /> I � o <br /> L : Z <br /> O <br /> I � <br /> d <br /> I °p <br /> i <br /> 7J ad r w m Z <br /> a < m c m <br /> _ F <br /> N _, C� y n m <br /> Z O O <br /> in <br /> /�— a <br /> Cr.......... o C <br /> .... ..... <br /> M <br /> Signature of O ner or Agent Date X . <br /> Remarks ......................................................................................................................................................................... T my <br /> m <br /> ........................................................................................................................................................................................ .fit l <br /> ....................................................................................................�/^/y.................�✓.......,,t././..... ........................................... <br /> Inspection Date ....................................... / / ......... EI�' u u o' U o a m <br /> .............. .................9...... . . .�............ m <br /> Zonin Adm lstrator 8 8 8 8 8 8 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 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 Arlon inlstrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />