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Burnett County Office of Zoning Administrator Iv 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 described and '� ~ C <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the A M L+S <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 `g <br /> regulations of the State of Wisconsin. <br /> 7. <br /> .... <br /> c.P.ffA.......� t.r ..tri................................. . ..... .A.C.K.......!wL.�r .��............................ ...... F <br /> OWNER (please print) <br /> /� y T....I...S.7..Y../•Y.....LU..... ................................ CONTRASCSTOR { (J ./L ......................... ......AD - s <br /> 33 <br /> ..sA.k tiAf.....W/4.......... ..`f. .7U.............. ......s '.o..ar�� .. . o.l....... <br /> ADDRESS �•-G� �7 ADDRESS .. .�....... .. .. ... .. . .... -J, <br /> PHONE.. ..`.?....1.•.. ../.... .. ..^....................................... .PHONE........... ,f.-.-.....4..-7. . ................... ...... 1 iS <br /> ........................................................................................... . ................................................................................... ...... <br /> PLUMBER WELL DRILLER <br /> 1 <br /> . . . ................................................................................ . ................................................................................... ...... O <br /> ADDRESS ADDRESS c <br /> .......... <br /> .. . . .......... ................................................................ ......................... 0 1 <br /> . . . ............................................................ ...... o <br /> PHONE PHONE N <br /> DESCRIPTION4. Sanitary Facilities: ° o 0 <br /> 1. Work: No. Bathrooms `r <br /> 2. New Building Details •• <br /> New Building „!\.... Type of Construction: No. Bedrooms ... ...... i R <br /> Addition /.Q/.IM .- ,.,,,, Septic Tank Size Gals. ... ...... <br /> Sanitary .......... Size ...,�.:: .. ft.x ..y ft. ... ...... i 0 i iN <br /> Fining/Grading � 1S 4a. Absorption Field Site: <br /> Moving ......... Height............. Stories .....J... ... Soil Type ............................. ...... i Aii' <br /> D <br /> .......... Area ....... ...... H1h� y•� <br /> in C <br /> Mobile Home .......... Slope ................................... ...... <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ............................ ...... <br /> Well .......... home,garage,motel, etc.) Dry Well ... ...... <br /> Subdivision /� [ Seepage Trench ... ...... o O <br /> .......... ..........1,T../.7.�A6...-.............. . : V: �E <br /> Camping Unit ....................................... Privy <br /> .......... ........... . . . ...... <br /> Seepage Bed ... ...... �'' D �: <br /> _____________ __ __ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc. should be sketched in Fig A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is locatE d at �'4 A O g 0 <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersecti n. <- <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Tom„Tt v,, o.� <br /> _____________________________________________________________ _ <br /> 5. Lot Size: Fig. A. 6. Location* <br /> :y O <br /> b <br /> ..b..(o.q... ft. x .L•�..C... n. - ./..S?.lt.4/?�f. 5q.ft. .............. ...... Q.Y.VNJ.K <br /> O o zi <br /> t\ F <br /> M _ ` o Efi y` <br /> 0 <br /> ^ m: <br /> i! r <br /> b t iZF C <br /> I C X K7iKl� qJ ky <br /> z <br /> S` ro <br /> O � � p° <br /> fr <br /> Ir,: <br /> m c � m r n W ca <br /> ' cm aa >D <br /> N p m m <br /> I I <br /> Z5!6 W •Z D <br /> — / <br /> n : m <br /> Signature of O n oFAen <br /> gW SDat)l F.F. > O <br /> Remarks ................................................................................ m w . <br /> m •• <br /> w. H <br /> OO <br /> Inspection Date ....................................... N m N m <br /> .... ............. ................ . . ..........i. E N N N O O N m <br /> Zoning dministrator...... .. ... $ $ $ $ $ $ y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appiic tion 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 been i sued. A permit maybe <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />