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Burnett County Office of Zoning Administrator v 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as '� Z 'V <br /> t4 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use - c ;( n <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n J <br /> ........................ <br /> OWNER (please print) COIVSRACTOR arSS RVEYOR or AGENT m r� <br /> —V <br /> 7L,......L%1 <br /> ADDRESS ADD R€SS <br /> r <br /> ........................................................................................... .. /.. <br /> ADDRESS ADDRESS <br /> W <br /> PHONE................................................................................ .PHONE................................................................................ <br /> ........................................................................................... . . . ........I'L'L ....................................................................... <br /> PLUMBER WELL DRILLER <br /> .......... <br /> ADDRESS ADDRESS <br /> n o <br /> . . .................................................................... . ................................... . < <br /> PHONE . ..................................................... <br /> PHONE Z H <br /> DESCRIPTION 4. Sanitary Facilities: P o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> .......... I <br /> New Building ......... Type of Construction: No. Bedrooms .......... i ? ' <br /> 0 <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary Size ft. x ft. ......... <br /> ' <br /> .......... .............. .............. <br /> Filling/Grading „ ,,,•,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving <br /> Soil Type .................................... <br /> .......... ........................................... r <br /> Mobile Home $IOPe .......................................... o <br /> .......... .. <br /> Privy .,......., 3. Use (describe exactly, 1 -family Fare. Rate ................................... <br /> Well ......•... home,garage, motel, etc.) Dry Well .......... <br /> SubdivisionSeepage Trench .......... <br /> .......... .................................................... <br /> Camping Unit Privy ai <br /> ............ Seepage Bed .......... <br /> ____________________________________ .N <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 <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 /> �s <br /> 5. Lot Size: Fig. A. 6. Location: ' <br /> ................ ft. x .............. ft. . ............................... sq.ft. .............................................................................., <br /> J <br /> N o <br /> 0 <br /> 0 <br /> T <br /> Z <br /> 0 <br /> v <br /> i�- <br /> M . y ' fid M <br /> cr < ° _ F <br /> (Nfl <' '10 <br /> � m . m <br /> Z o J n 70 <br /> iNcp <br /> %d .. PLC <br /> .'�.....°....``........ \ a 0 <br /> o c <br /> g Agent// ,,.,t L/ Date X <br /> Rem arks ,Q•C/ne6�r1.A e..L'l:G=.4�.tt..... �7 m m <br /> m <br /> ........................................................................................................................................................................................ <br /> Inspection Date ....................................... 'L” /`.� ��1 t✓ ` aC — - - m — N Ri <br /> € 1'- PPPff P m <br /> 10 Zoning Administra or <� 0 8 0 8 0 8 y <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 Adm inistratot. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />