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Burnett Caunty_ Office of Zoning Administrator p 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 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 0 C '•R <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> TTOL37 YI- h I.� -f►ea ....... .: .................. ......:......... ..................... ..................... .............................................. . 0 <br /> OWNER (please print CONTRACTOR or SURVEYOR or AGENT o. <br /> .= .C?......t 11 .5 t ^1...... .................................................................................. <br /> A=RE ADDRESS <br /> � .: ?.�..{..m.N....ism 1..9.......................... ............................................................................................ <br /> .. DRESS ADDRESS .� <br /> .�a.- CiD.`�..................................... ............................................................................................ <br /> PHONE PHONE <br /> ........................................................................................... . . . ..................................................................................... <br /> PLUMBER WELL DRILLER :T <br /> ........................................................................................... . . .............................................................................. '� <br /> ADDRESS ADDRESS <br /> 0 o <br /> c <br /> ........................................................................................... . . .................................................................................. O <br /> PHONE PHONE...... .. Z H <br /> DESCRIPTION4. Sanitary Facilities: ° 0 0 <br /> 1, Work: 2. New Building Details No. Bathrooms <br /> .......... , <br /> New BuildingType of Construction: No. Bedrooms .......... o <br /> m <br /> Addition . .................................................... Septic Tank Size Gals. .......... <br /> .......... <br /> Sanitary Size ft. x •""""' <br /> .............. .............. ft. <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ...................... Soil Type ..................................... <br /> Mobile Home Slope .......... ..... ....... <br /> o <br /> 3 .. <br /> Privy ...X... 3. Use (describe exactly, 1 -family Pere. Rate ................................... b :� <br /> Well ...X... home,garage, motel, etc.) Dry Well .......... F i <br /> Subtllviaion Seepage Trench .......... M <br /> .................................................... Y <br /> Camping Unit ,,,,,,, Priv ;1s.............44......4.............................. Seepage Bed <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road N <br /> setback, side and back yard dimension and location and setback from all bodies of water. If <br /> 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 N <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ,N p <br /> -----------------------------------------------.__ P <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... T :us <br /> � 3 <br /> N O <br /> o <br /> mf,waRQ LAKE- RD o . <br /> w . <br /> fi � lel <br /> to m icro � <br /> Q� Pr►'v <br /> :a <br /> _y o <br /> z <br /> p M �' ml <br /> 0 COO <br /> C c w <br /> F <br /> � a m' <br /> y m ,D <br /> oH: m ' =o. m <br /> 0 00 na � 70 <br /> i» - m3 <br /> Signature of Onwner or Agent Date : X <br /> Remarks ...l..yu./G�RCr1rK' ' "C11...1�.................7,�................................................................................................... <br /> m . <br /> .... //tt ........... ....... . . . . ... .. .... <br /> V <br /> .................................................... . .................................... .. S <br /> : « <br /> TmIns <br /> Inspection Date ..................................... ......... ..............dtat ............ ... <br /> Zonin9Amr4or <br /> 8 8 8 9990 <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 Ire made without approval of the Zoning Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />