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G'� Z ),/ <br /> Burnett County Office of Zoning Administr flor <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 describec and C <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the + <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the law and <br /> regu tions of the State o*isconsin. <br /> hr.... <br /> . ..... .. ...... . ... ... . ..C�.r. ......................... - <br /> OWNER (Pie print) CON�gACTO r SURVEYOR or AGENT <br /> K�.,... .. ...... Q ...7.Q........................... ........ <br /> ADDRESS AD ESS <br /> !� .. <br /> ..1....1 .....�49..... .... ........... ........ <br /> ADDRESS ADDRESS ;yyI <br /> ........................................................................................... ... .............................................................................. ........ Y\ . <br /> PHONE PHON.. E :1 <br /> ........................................................................................... .WE.. ... ..... . I'Ll,.E............. <br /> ................ <br /> ............. <br /> .................. <br /> .. ........ 1 <br /> PLUMBER LL DR.. ILLR <br /> . . . ................................................................................ ...AD...DRES.... .... ..................................................................... ........ <br /> ADDRESS S i n 0 CD <br /> ^. < <br /> ............... . . .................................................................. ................................................................................... ........ o <br /> PHONE PHONE „� <br /> 9 , o <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> v <br /> 1. Work: 2. New Buildin.. No. Bathrooms Details """"' � o <br /> New BuildingT No. Bedrooms <br /> .......... Type of Construction: ' ..... .. i R <br /> Addition .................................................... Septic Tank Size Gals. . ... <br /> Sanitary .......... Size .............. ft. x .............. ft. . ........ <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type ........................... ........ o <br /> Mobile Home .......... Slope ................................. ........ .. <br /> Privy .......... 3. Use (describe exactly,'1 •family Perc. Rate .......................... ........ i <br /> DWell n <br /> Well """" <br /> .. .,, home,garage,motel, etc.) ' m <br /> e Trench o <br /> Seepage <br /> Subdivision <br /> .......... <br /> .................................................... """"' <br /> Camping Unit Privy Cr t� <br /> (� <br /> Seepage Bed ........ O OE <br /> ------------------------------------------------------------------ --- C' i li y <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in F g. A. rC. P: <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loc ted at 'L:o)W g <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the int <br /> erse tion. g1 `„- <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :(luW 0 <br /> ------ <br /> 5. Lot Size: Fig. A. 6. Location: ;V,j (A <br /> ................ ft. x .............. ft. - ............................... sq. ft. ..................................................................... ......... <br /> A o O <br /> Abbchod CSL 0 <br /> N 0 <br /> 9— /o <br /> — / � W <br /> 0 <br /> p <br /> T �y <br /> 'ry Il1J <br /> O �J <br /> v <br /> b <br /> M <br /> N CW d 0 Cm C� <br /> n HQ < > > n - - m <br /> m moo.•< -� o• m asy <br /> ON '� O m0 3 <br /> Z O > 1 <br /> o �� Cn <br /> rn <br /> _ a : y <br /> on 0 <br /> ..... . ........ . . ............................................ <br /> . . . ......... p 0 <br /> M <br /> M <br /> ...... ................... .. <br /> Signatur.... .. e of Ow.. ..ner.... or Agent Date 8 <br /> N <br /> Remarks ......................................................................................................................................................................... m <br /> 0 <br /> o . e <br /> O : <br /> Inspection Date /. f N M <br /> ;! <br /> ....................................... .... . . . .... � NUNioo <nm <br /> Zoning Administr' or 1 �� 8 8 8 8 6 8 N <br /> 9.. <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f acilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this api lication 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 ben issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans o specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANDA PROVED. <br />