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Burnett County Office of Zoning Administr 3tor �' c <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 describec and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the law and 3 {,)J <br /> regulations of the State of Wisconsin. — <br /> . . . ...... . ................. . . <br /> CO <br /> OWNER (pleats print) NTRACTOR or SURVEYOR RVEVOR or AGENT � v <br /> �.3......LgA....1. . L............................................ ................................................. .................................. ....... a \ \ <br /> AD RESS 11 ADDRESS <br /> ST. ........... ` ................... <br /> v. <br /> b J...v.: I ....�.......... E + Y 1 <br /> ADDRESS ADDRESS <br /> cCE i� <br /> ............. .(R.kz..-.dd�. l................................................... .................................................................................... ....... <br /> PHONE PHONE <br /> ........................................................................................... . ...... . .. . ............................................................... ....... <br /> PLUMBER WELL DRILLER <br /> O <br /> . . . ................................................................................ .A......RES. . ....................................................................... ....... 0 <br /> ADDRESS DDS n o :� <br /> ........................................................................................... .PHO-H-O-N..E.......................................................................... ....... : O .i <br /> PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms /...... o <br /> Now Building ... Type of Construction: No. Bedrooms . ... <br /> Addition ...�,.. ... .....................................`. Septic Tank Size Gals. <br /> Filling/Grading •• •• Hei ht.. �tl 4a. Absorption Field Site: <br /> MMoving obile Home . ...... . Size ...�.d.V...;. p.4t1..... ..4..�. .. . <br /> �y ft, x ...(. <br /> g G..:'. Stories .....�.. , <br /> e... Soil TYPe...............::........... ........ C i <br /> Slope ......:.......................... ........ <br /> CT <br /> Privy 3. Use (describe exactly,'1 •family <br /> Perc. Rate ............. <br /> o :ry <br /> Well ,,...,.,,, home,garage, motel,etc.) Dry Well <br /> Subdivision .,,...,,,. Seepage Trench 0 i <br /> .1.....-F.n.rh.lJ�.....Haun1e............. Priv . ........ p <br /> Camping Unit ,,,,,,,,,, Y �- <br /> .................................................... <br /> __________________________________________________ Seepage Bed_________ __ <br /> CA <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. t �` C <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is loca ed at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. - <br /> ___________________________________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: '� E <br /> q <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............. °L,..UQ.0....k'a.l(.G'.................... ........ <br /> O <br /> � <br /> it <br /> Sursy 4'e �' j � �o`�\e'er <br /> o f <br /> :I o' <br /> —10 ..e`v1J 1 <br /> W <br /> iya <br /> 9 <br /> 35 v <br /> r�o rh <br /> <nvmrDmm ,o <br /> �a� aM a a M <br /> o Fno � � N D ' -i <br /> r,Cr.} 3o ffi"aid ._ 2 s <br /> o mom <br /> x....... ......).R! .....d�....... .. .. ..................... ... ......... r` ; : O <br /> Signature of Owner or Agent Date o' <br /> o . <br /> Remarks <br /> m .. <br /> ✓ ! !.............. . o o6� . . a . G..Tn��...... . .... .. . .... ... i ...... . . . 1y <br /> i// NOG N � m <br /> Inspection Date ............. ......................... .. . .. ......... /� .... U O N O O NN m <br /> S <br /> Zoning Adm nistrator il�� g g g <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary is ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has bee i issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or ipecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />