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Burnr,�tt County - Office of Zoning Administrator0 <br /> iv o 7 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 :` <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as — o \ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c i <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> o . ... s 3 <br /> .. ( ................................................ .....F.7--.C.4:.... ....... .........r.... ENT... <br /> peaser int) �J C "'or.lng _ 4"h <br /> ................................ .......................................................... Z <br /> ADDRESS ADDRESS <br /> Sfi . • <br /> T.. .R. ............... . ............ . . �, � / ° <br /> ADDRESS .. .................................................... <br /> ADDRESS <br /> PHONE........ ......................... ..... ....................................... ..... . . . <br /> .. . . . PHONE a� � �........................................ <br /> . ... .. .......... ... ............. ................................... . ... ...................................................................................... � <br /> WELL DRILLER <br /> ADDRE \.................. <br /> ........ . . O <br /> ............... .. <br /> 7........................ .ADDRESS............................................................................ <br /> 1N7"1? <br /> L7 <br /> . . .. ... . .............................. . .......................................................................................... <br /> i <br /> PHONE 3 PHONE o <br /> 7................... Z <br /> 4 <br /> DES IPTIO. . N. .. o � <br /> . Sanitary Facilities: � o o ; <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details .......... ��� 0 <br /> New building •„! Type of Construction: No. Bedrooms .......... 'Oo <br /> Addition ,•........•, Septic Tank Size Gals. ......... � f0 <br /> Sanitary ., .... Size .............. ft, x .............. ft. ......... <br /> Filling/Grading .. ....... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... AreaSoil Type ........................... <br /> ........................................... ......... <br /> Mobile Home Slope o <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................. °” <br /> Well ..k,•, home,garage, motel, etc.) Dry Well .......... w <br /> Subdivision Seepage Trench v>' ' <br /> .......... .......... <br /> .................................................... w <br /> Camping Unit Privy <br /> -------------------------------------- _--- Seepage Bed---- .......... <br /> -- ---------- ------ <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY ° " 1 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Fig. A. Include road J c <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property is located at a highway inter- M a <br /> LABEL EXISTING ^- oZ <br /> 5 <br /> ------------ -------------------------- <br /> 5. Lot Size: <br /> Fig. A. 6. Locatio <br /> q��,�• 9 0 <br /> ft. x .............. ft. — zali -�.^........ sq. ft. ............ � ----- <br /> �p e <br /> IN <br /> °J 0 o. <br /> to ' <br /> � o <br /> 0 <br /> 0 <br /> /X AAP <br /> U/ s <br /> 2 A&o <br /> 5 1cn�— <br /> �t < ' <br /> goo <br /> let- <br /> n to 27 P ? F <br /> T. ry p- S: — m n m <br /> cn < ,� m c -0 <br /> m <br /> m <br /> o <br /> ................................................-...........Q— Yom, <br /> p <br /> nr Agent Date 0 C_ <br /> X M <br /> Remarks ......................................................................................................................................................................... m m <br /> v <br /> ........................................................................................................................................................................................ <br /> ......................................................................................................... ..... .................... <br /> Inspection Date ro N m <br /> au Boum <br /> Zoning Adminis for g 8 g ' g g y <br /> NOTE: A preliminary site inspection must be mad and site approval granted on all structures involving sanitary C ties <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be atta 1 to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any I ulld- <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 Arlon imstratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />