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a <br /> Burnett County Office of Zoning Administrator d - o 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 '< — <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. a i iiJ` <br /> 3 <br /> o <br /> eNn.r.. /..........���......!1..d.�..N...................... ................................................................................... <br /> N ......... <br /> 0 ER (please print) CONTRACTOR or SURVEYOR or AGENT _ <br /> . . ... ... .... .. <br /> d 5� <br /> ... tis — ` <br /> AADDRESS/ ADDRESS <br /> - y/ <br /> ./L �.SI'1. ......-.'.LL..!.L::........... ..1.1...'!................. .ADDRESS............................................................................ <br /> tXJ i <br /> ..................................... ................................................... ............................................................................................ <br /> P ............................................................... PHONE .................................................................., tJ <br /> PLU BE WELL DRILLER � . <br /> ADDRESS............................................................................ .ADDRESS............................................................................ rt. o <br /> < <br /> ........................................................................................... .PHO'H-0-NE.................................................................................... o ,» <br /> PHONE <br /> Z � r <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 ° :13 <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building ,.,,,,..., Type of Constr 'on: No. Bedrooms ,.,1....... W a <br /> m <br /> Septic Tank Size Gals. /� .. , <br /> Addition .......... ....... .......................... I -: < <br /> }.............t. o:�r <br /> Sanitary ,,, Size .............. ft. x .............. ft. <br /> "... 4a. Absorption Field Site: t/a <br /> Filling)Grading ........ Height........... Stories ............... <br /> Moving ...... Soil Type .................................... <br /> .......... Area ..................................... t. Sr o <br /> MobileHome Slope .......................................... ,+ <br /> Privy .......... 3. Use (describe exactly, i -famil Perc. Rate ................................... <br /> Well ...I...... home,garage, motel, etc.) Dry Well .......... JT <br /> Subdivision .......... Seepage Trench .......... <br /> Camping Unit .......... ................................................................ <br /> ............ Privy N(� (,., <br /> Seepage Bed U/\3.�].. ,M1 <br /> ------------------ ------------------------------- --- ------ -- b <br /> � 1St <br /> Location of proposed structures and existing structures, well, sewage systems, roads h <br /> eta, should be sketched in Fig. A. Inr,ud. road Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If proor rty Is ionated at a highway Inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLf ARLY LABEL EXISTING N-1 = <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �A) o <br /> 5. Lot Size: Fig. A. 6. Location: O <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> in <br /> N o <br /> o � <br /> 3 <br /> a" o <br /> s <br /> 1J <br /> T <br /> z <br /> O <br /> d <br /> 7 <br /> II � <br /> V �PV^y <br /> 7 V r m m Z <br /> t <br /> J w m <br /> a cn < C ' t'< e c M <br /> = m <br /> nS70 <br /> O _O n ro <br /> �..�0 M <br /> \I\ .. .... ............... ik�j 0 p <br /> Signature..of er or Agent Date -_�� o C <br /> /, ' X T <br /> Remarks ... ....<.i../.,6..0 1/. !`..'...................................................................................................................... rrC <br /> ro : <br /> eet <br /> ........................................................................................................................................................................................ — _ <br /> 77........................................................................................................... ...�..- ..................................I.......... <br /> rr <br /> Inspection Date ..J ..... .. � <br /> .. ..... ....... .... m <br /> Zoning Administrator 0 0 <br /> CA <br /> NOTE: A preliminary site Inspection must be made and site approval granted on all structures involving sanitary faciliticr <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attacher) to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any hnlld- <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 lie, made without approval of the Zoning Administratui. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />