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Burnett County Office of Zoning Administratoro 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT - 3 <br /> o <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 Wls onsin, <br /> ie�ae N <br /> d <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a `° <br /> Snl!we rf 'e a 0 <br /> S S7 w W a�S — .R — <br /> ADDRESS ADDRESS { � O <br /> 1 <br /> .............. ...........�....1�1.........5 ...................... ..................................................................................l......... <br /> ADDRESS ADDRESS PQ <br /> . ....... .... ... .. ..... ..... <br /> ............................................................................. .PHONE......N-E-............................. <br /> ........ . . ... .. .. .1. ... Q <br /> PHONE <br /> PLUMBER............................................................................ .WELL DRILLE..R.........................................................�........, <br /> . .... E"S"S' ................................................................. ......... p <br /> ADDRESS AD.. DRESS n O <br /> < p <br /> PHONE PHONE I Z <br /> DESCRIPTION 4. Sanitary Facilities: ° <br /> No. Bathrooms '1 <br /> 1. Work: \/ 2. New Building Details """"' •J o '• <br /> New BuildingNo. Bedrooms N...11 Type of Construction: ...... ;� z <br /> m <br /> ......... 0 i <br /> Addition .......... .......... . .............+............. Septic Tank Size Gals-.- < <br /> Sanitary ......... Size �`i ft. x .3.`?1.... ft. '"••'••• <br /> Filling/Grading ,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Off : <br /> Moving Area ........................................... Soil Type .......................... ......... o <br /> Mobile Home Slope ....................... � 0 <br /> .......... '^. ......... <br /> Perc. Rate ............... .N. o . <br /> Privy ,,........ 3. Use (describe exactly, 1 -family �--�` W <br /> Well .......... ho e,g rage, motel, etc.) Dry Well I.......... J i <br /> Subdivision ,,,,,,,,,, ! /L/ Seepage Trench .......... <br /> .................................. <br /> -17 <br /> Camping Unit .......... Privy .......... <br /> .................................................... Seepage Bed <br /> -- <br /> Location of proposed structures and existing structures well, sewage systems, roads, etc., should be sketched in Fig. A. Inclu e road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwa inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL FXI 3TING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. f <br /> --_---_—_----------------------------------------------------------- <br /> 5. Lot Size: nn Fig. A. 6. Location: (7 m <br /> �....... ft. x .Qf.6G_. ft. — ............................... sc1. ft. ........................ ................T'.``. ..... ..... .......... <br /> 1liofe <br /> �rrtlarP3� 4N o <br /> � <br /> N t Ila <br /> � 0 <br /> J— <br /> o <br /> \ Citi -3 Nd�Drrd� <br /> vaa � �_ af <br /> 'o cNn <' M n' mm <br /> — — _ — z So' � � n 570 <br /> .......... V. . <br /> S� u e of Owner e ate <br /> X o <br /> m m <br /> Remarks .......... ................................................................................................................................................i....... m : 0 <br /> ?U: <br /> II <br /> Inspection Date <br /> f. U (NT O (Old O tT <br /> Zoning A mistrator S S o S S <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures i�tvolving sanitary faculties <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolal test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE �IAND APPROVED. <br />