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Burnett County Office of Zoning Administratorv o✓ o <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 '< N :"'s <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m Ql <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n ' : <br /> a <br /> p / _ d O <br /> ...........15 <br /> .....�.u.'4t�:s .6..rr.................................... ...... ........................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> ....../.5.. . .......CT:�1.O�UI.K .................... ............................................................................................ <br /> ADDRESS J ADDRESS <br /> ............. .. /.T.Irl-.I-................/.....2...1./1t.�1 I SS�.�R ............................................................................................ <br /> ADDRESS ADDRESS <br /> pp ? pp <br /> .................?.�a......... 1.e..'...................................... ............................................................................................ <br /> PHONE PHONE ?� <br /> .......... <br /> PLUMBER............................................................................ D <br /> .WELL RILLS..R...................................................... <br /> ... <br /> ........................................................................................... .ADD.............RES.............................................................................. <br /> ADDRESS S 0 0 <br /> o <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: <br /> 2No. Bathrooms v - <br /> . New Building Details <br /> o <br /> New Building .... „•. Type of Construction: No. Bedrooms .......... <br /> Addition Septic Tank Size Gals. .......... '• <br /> .......... ................. ................ . .... <br /> Sanitary . <br /> .......... Size ..7i.y..... ft. x ...off ... ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... Y` r Mobile Home Slope <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... V i <br /> Well ..........,,,,,,,,,, home,garage, motel, etc.) Dr Well .......... <br /> subdivisionSeepage Trench .......... ? i <br /> .......... ......../... ....................................... <br /> Camping Unit .......... ....... . . p. Privy .......... <br /> ................... Seepage Bed .......... a <br /> ------------------------- <br /> --------------- -------------------- ----------- t <br /> N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- u a - <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING w < <br /> P <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... U i <br /> c e <br /> ^. <br /> N p <br /> A o � <br /> //till 3. <br /> �60 f <br /> ac/ f <br /> /Sa <br /> T <br /> 0 <br /> j <br /> F <br /> 3 d 1 co Nrv � .� E. <br /> yaa� m_ ' at <br /> m <br /> Z 80 - Da <br /> o n�' <br /> »: <br /> /// <br /> l,,.iy'nVl�%G ........ .... ..�.. ......'..`... ......,1 m <br /> 0 <br /> �a m <br /> �J`'�y '' p <br /> Signature of Owner or A r' Date .H1 ' C <br /> X <br /> Remarks NP. 7+. ...................................................................................................................... M 0 <br /> . . <br /> In <br /> Fn <br /> ........................................................................................................ . . . . o <br /> ... . . . .... <br /> ..................................... <br /> `. <br /> N <br /> Inspection Date ....................................... ��..�ra,G.P.. . . . . .:......�..... �� ?'. .................. � o o iK <br /> Zoning Administrator '; ✓ 8 8 8 8 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />