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Ca N �. <br /> Burnett County„ Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3• o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and S <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 `8 <br /> regulations of the State of W' consin. T a <br /> 1 .L..C.9..'!..h.........P'I�0)Otr lliG.r.................. ..................................................................................... ...... A <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> n b <br /> . ...... . .......... . <br /> ADDRE$ ADDRESS n <br /> .... ................................... i� <br /> OUt2 1 JC <br /> D 1� <br /> ADDRESS i ADDRESS <br /> .............. 4�klr�.l... ... ?� 0..................... ....... . a <br /> . <br /> ( s <br /> PHONE PHONE �. <br /> �. . IN..P.. !... !. ?.................................................. ............................................................... ...... i <br /> PLUMBER WELL DRILLER <br /> is <br /> .......................... ..... <br /> ....................................................................................... _. <br /> ADDRESS ADDRESS n O :7 <br /> c <br /> . .................................................................................. ....... o' :4 <br /> PHONE PHONE Z 3 r <br /> DESCRIPTION 4. Sanitary Facilities: P c ° <br /> ms " """'th <br /> Baroo <br /> 1. Work: 2. New Building Details No. ':�O 0� <br /> New Building „ ,,,,.... Type of Construction: No. Bedrooms .. ....... <br /> . . i” <br /> Septic Tank Size Gals. 0.0 t•'b <br /> Addition ... ........................................I........... a,t <br /> Sanitary .,�... Size .............. ft. x .............. ft. Q .r..P.T9.44 . ....... <br /> 4a. Absorption Field Site: <br /> Filling/Grading <br /> .......... Height............. Stories ............... 1ST <br /> i' }, r i <br /> Moving .......... Area ........................... .............. Soil Type ............................ ....... o <br /> Moblla Home .... Slope .............. ................... ....... <br /> ...... <br /> Privy .......... 3. Use (describe exactly Perc. Rate ......�.•"•""""" <br /> ,�1 -family """" o ' <br /> Well .......... home,garage, motel,etc.) Dry Well <br /> Z <br /> subdivisionSeepage Trench .. ....... o i <br /> .......... .................................................... ' <br /> Camping Unit .......... .................................................... Privy .. .... T <br /> Seepage Bed <br /> --------------------------------- ------ -_. ...— <br /> -- ,R9 i- c i <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. :U) T <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. . O <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: . <br /> ................ ft. x .............. ft. . ............. sq.ft. ...................................................................... ........ ? '•r'I <br /> 7 � <br /> � n <br /> N o <br /> o <br /> � r <br /> o � <br /> 0 <br /> � o <br /> 1 1 <br /> h z €oa <br /> o <br /> ft <br /> n c < n c m <br /> m vNin'c — am nay <br /> a oc mC0 � � ; <br /> O He O m r0 <br /> D - 1 <br /> rnn y <br /> o 2 <br /> a X0 ; 0 <br /> yA m <br /> . . ...... .................................................... ...................................... <br /> Ri� ature of ner or Agent Date o <br /> 0 <br /> Remarks m <br /> N . <br /> fl' o <br /> .. ....................................................................................................... .... ............. ................ d� <br /> O N_ a � oo � m <br /> ...... <br /> Inspection Date ....................................... <br /> ........................... <br /> Zoni Administrator Co <br /> NOTE: A preliminary site inspection must be made and si approval granted on all structures involving sanitary f cilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app 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 oi 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 />