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Burnett County Office of Zoning Administrator u o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT '- 3 <br /> d <br /> ' \ <br /> THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as •� N O <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 ma W <br /> � . - _ <br /> .r.�.. . ..�Z.... �. y..... ale,. l ..... . ........... y) – g (� <br /> OWNER (Please in CONTRACTOR or lJ - �p75 O <br /> ADDRESS •• ....�7....�zj... .......................................................................... ... ............. <br /> .-. <br /> 'rfr <br /> ADDRESS m <br /> ................................................. ° <br /> ......./(J. ..t� ............................... <br /> R['J ESS ....................... ........................................... <br /> AD <br /> ADDRESS <br /> ............. <br /> PHONE .PHONE................................................................................ •1 :: <br /> PLUMBS . ......L'..............h ..... .. ............................................................................................ <br /> ............. ...Yl........... :� /,✓ . /oC� WELL DRILLER - <br /> ADDRESS !`// ADDRESS............................................................................ C� <br /> 71 0 o <br /> tea....4�:...���5... .. .. .��..... . .......................................................................................... <br /> �. <br /> PHONE PHONE ° <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms �'� L• <br /> .......... <br /> Q <br /> New Building Type of Construction: No. Bedrooms .......... 3 i0 <br /> .......... <br /> Addition ank Size Gals. ..... <br /> Sanitary ..... Size .............. ft. x .............. ft. ���� �G <br /> Fillip /Gradin 4a. Absor tI Field Site: <br /> g 9 .......... Height............. Stories ............ .. P re i <br /> Moving .......... Area ........................ Type ..................... <br /> Soil ''1 •� <br /> ................... ............ . <br /> fi r <br /> Mobile Home .......... Slope ............................. o <br /> .......... ... � .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... - <br /> Well .......... home,garage, motel, etc.) DWell .••....... <br /> Subdivision .......... Seepage Trench .......... E <br /> ..........................................I......... <br /> Camping Unit Privy <br /> -------------------------- --- __-Seepage Bed .......... <br /> -ation of proposed structures and existing structures, well, sewage systems, roads,etc <br /> ., should be sketched in Fig. A. Include road <br /> ck, side and back yard dimension and location and setback from all bodies of water If property is located at a highway inter- p a <br /> in, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXIS <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS <br /> TING �'` 5 <br /> . •C <br /> -------------------------------------- �- ;, o <br /> p ' <br /> 5. Lot Size: Fig. A. 6. Location: C� (� <br /> ft. x .............. ft. — ............................... sq.ft. �� •� <br /> 1 <br /> Gted Mow,d <br /> N :> p <br /> 0 <br /> ' °9 <br /> NN <br /> • \\ :,r ° <br /> Z <br /> 0 <br /> d <br /> wWZ <br /> m . <br /> zP o on s <br /> _ m <br /> Ca <br /> -5, m <br /> 0if <br /> pxignawner or Agent �. Date E C <br /> Remarks . r. .� — �`P . . . <br /> ..`�.......�` <br /> m <br /> . ....................................... . ... .. <br /> /. L2......................✓ ..................... <br /> . II <br /> is ection Date 3 �J /l � <br /> p ...............I...................... �??7u!.. ....:..... .. <br /> .. ........... ....... ................ <br /> ov, omm <br /> Zoning Add b nistratorx >• $ $ $ $ $ rn <br /> A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilitius <br /> -nstruction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> - n before a permit will be issued. Do riot purchase or install a septic tank, do any plumbing or start any build <br /> - <br /> _...:it has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> to exist. Changes in plans or specifications shall not he made without approval of the Zoning Adm Inistrator. <br /> ;TEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />