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ity Office of Zoning Administrator &' - o 0 <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 r� <br /> N » O �. <br /> TO ',{E ZONIrG ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> shorn herein. Tie undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Saniution Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ,� C = <br /> OWNER...... . . l.:!..{•. PP............................................ ......R:.�.................... aS. I..b ............................. O <br /> ry'' <br /> (pie se print) CONTRACTOR or SURVEYOR or AGENT c, <br /> A.......................................................................................... y/J]Q a <br /> DDRESS ADDRESS� "� .'r �j.�.�.............................................. � <br /> ADDRESS............................................................................ ...................... n -.' .. <br /> .. ....t...... ., <br /> .......... ................................... <br /> ADDRESS <br /> PHo.................................................................................... 3 y ... <br /> NE ............................� - ..................7.................................. <br /> ............................................................................... .PHONEi^ <br /> . . . ... _1 <br /> PLUM BEH ........................................................................................... <br /> WELL DRILLER <br /> ........................................................................................... . ...... . . ............................................................................... <br /> ADDRESS ADDRESS CD <br /> n o <br /> PHONE PHONE Zu, r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> t. Work: No. Bathrooms <br /> 2. New Building Details ••• •••••• +++''' o ' <br /> New Building •.X Type of Construction: No. Bedrooms ..... �T <br /> Addition Septic Tank Size Gals. .......... <br /> ......... ..ize ....................x ......,.......... .• <br /> Sander .......... <br /> Sanitary ..... .... Size ..���..... ft. x .�.�;..... ft. - <br /> Flliing(Grading „ ,,,, Height............. Stories ..A.......... 4a. Absorption Field Site: <br /> Moving .......... Area ..id�.'lob.�l-........ ........ Soil Type .................................... r <br /> pp�� µ E <br /> Mobile Home /� 4.ffwF�rX 3.Z'. $IOPe .......................................... o <br /> .......... 1, yy• <br /> Privy AAAA.,,,,, 3. Use r7scribe exactly, 1 •family Perc. Rate ................................... -"D f <br /> Well X,•,, home,garage, motel, etc.) Dry Well .......... �k <br /> Subdivision •••• }.� _ rru Seepage Trench .......... i <br /> .... . . ...... ...... yf............. <br /> L <br /> Camping Unit .......... V .. .V •.............. Privy .......... <br /> .................................................... Seepage Bed <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures well, sewage systems, roads,etc., should be sketched in Fig A. Include road Cr •Q ?1 ' <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- i p- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING c <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS.---------------------------------------------------------------------- <br /> J N <br /> O <br /> 5. Lot Size: Fig. A. 6. LocatiQf� _ '< <br /> -1�....... ft. x F30�.... ftp— ..�O.b`�.�.�....... s9.ft. �!�... <br /> 0 <br /> IN 0 <br /> cl <br /> co �� <br /> a <br /> F'N3 .T <br /> `1 H <br /> I �— <br /> o <br /> \ t9t <br /> IrE ° <br /> r F fcr <br /> -a9RtA JJCf) r W a 2 <br /> / If _ a <br /> TC L3i? <br /> ADO l�YtaC�eYI an a m m <br /> Z Oo Da <br /> 0 <br /> n S � <br /> —� nm <br /> ......................4l A <br /> �M i p <br /> Signature of 0 ,r7orlAgJent Da e0 / i Ao C <br /> Remarks ......! f; ... .. ... ....................... A.t.C....�i.5.rta+ / •% ..P. /vY> x C <br /> A n <br /> ... .-......�;......tir'�.r." .... !L......t...... .... ?.��......ts��..�.'`I. .....t.7. !'...`—J. ..�...� 1• .:... .... y li <br /> T <br /> Inspection Date ....................................... .. .. . ..... ................................. 0 <br /> r"ii o <br /> Zoning Ad nistrator irJ WE 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 buil <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 We made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />