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Burnett Gounty Office of Zoning Adminis rotor cn0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 0 <br /> < o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and to ated as <br /> shown herein.'the undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County L nd Use as m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wi cousin. 3 a <br /> o <br /> lis'.c..(... ......... .c...��..1-..................................... ................................................................................. .......... c <br /> OWNER Ipl ase print) 1 CONTRACTOR or SURVEYOR or AGENT o. <br /> w. ... .. .7- .r.........W.l.,...... lg�a........... ................................................................................. .......... <br /> ADDRESSSO< 3, '' j ADDRESS •* � � <br /> a-71.M `{lly E� <br /> ..... . . . ............................................................................... . .......................................................................................... <br /> ADDRESS ADDRESS <br /> ........................................................................................... ............................................................................................ <br /> PHO E PHONE ; '1 <br /> ... .oPfii.n...f................................................. <br /> PLUMBER WELL DRILLER <br /> O <br /> ........................................................................................... ........ .. .................................................................. ........... _. <br /> ADDRESS ADDR..ESS.. m LD <br /> n o <br /> ........................................................................................... ... ... ...................................................................... ........... o' ,» <br /> PHONE PHONE.. .. Z N r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building .......... Type of Constructicyr- . No. Bedrooms ,,. .... a <br /> Addition ,�4., �5,/�h� Septic Tank Size Gals. .......... �J <br /> .......... . .......... ........ .. <br /> Sanitary ... Size .............. ft. x .............. ft. �d..4..Ot <br /> Filling/Grading ...I...... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area .................................... Soil Type ........................ ........... r <br /> ° <br /> Mobile Home .......... <br /> Slope .............................. ........... <br /> Privy ..... .... 3. Use (describe exactl 1 -family Perc. Rate ....................... ........... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> subdivisionSeepage Trench .......... <br /> Camping Unit .......... .................................................... Privy <br /> .. ...... .. . . ........ .......................... ..pp <br /> Seepage Bed . <br /> ---- -------------------- ------ ------ ----- - -- <br /> .— <br /> N <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched In Fig. A_ Incli,de road c <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highw y inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL E ISTING � <br /> STRUCTURES AND PROPOSFD STRUCTURES AND ADDITIONS. <br /> �I o' <br /> 5. Lot Size: Fig. A. 6. Location: :� <br /> ................ ft. x .............. ft. . ............................... sq.ft. .................................................................. ..........., <br /> I N <br /> n <br /> ON o <br /> o � <br /> 3 <br /> (] 1 1 <br /> O <br /> 1 S <br /> N <br /> 0 J� <br /> O <br /> m <br /> I � <br /> V � <br /> ]] N r 9 y W Z <br /> C d < c N <br /> � <br /> < <br /> a a _ f <br /> N <br /> Z o o � D a 3 <br /> O _ O a <br /> e» 21 in <br /> m n <br /> ... ............. . . .. ............................................. ...................................... Qo C <br /> Signature of ner or Agent Date �vM1� <br /> IX 7 <br /> m <br /> Remarks ....... ................................................................................................................................................................ <br /> v9 <br /> ......................................................................................................... 1.^....-.�....,..^..-......�.}p/./�.�.9 ... ... .................................... <br /> Inspection Date I ' � s- C�. R <br /> p ` Zonin Administr r 000 o G <br /> NOTE: A preliminary site inspection must be made and sit�e� �a�.pp-rovval granted on all structures nvolving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatic n test must be attached to <br /> this application before a permit well be issued. Do not purchase or install a septic tank, do any p umbinq or start _ <br /> Ing until a permit has been Issued. A permit may be revoked of misrepresentation of any of the itiformation con <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of the Zoning <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APP <br />