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Burnett County Office of Zoning Administrator - 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application fora Perrrnt For The work described and located as — :per <br /> shown herein. The undersigned agrees that all work shall he done in accordance with the requirernents of the Burnett County Land Use c <br /> 1.7Q ion Code,and with all other applicable Count Ordinances and the laws and regulations of the State of Wisconsin. 3 0. <br /> 2... 4p..................y e _ �. O <br /> U p ... ..S .. ..:�..c�..k.' .......... C. ................V. . ... ........... ...T............................... <br /> Ordinance, Sanitation <br /> OWNER Ipleas Intl CONTRACTOR or SU RVEVOR or AGENT <br /> �.!..$0........ S.. ............................. ............................................................................................ r <br /> ADDRESS ADDRESS <br /> ADDRESS . ...... . . ............................................................................... °C <br /> r ADDRESS <br /> Ta.(Z.. � <br /> ................................... ................................... ............................................................................................ -4 <br /> PHOJ)FE PHONE r <br /> (l. J.R'ER c� ........_rte.....` .?4..5.e ��................. c i <br /> LU BER WELL DRILLER �"\ <br /> .X. .6..?...... ....�. S.fi .�..cJ..�.............. ..................................................................................... . ...DRILLER - <br /> 1A <br /> ADDRESS <br /> ♦oo o <br /> '7.5.. .... .. .2 ?..Q............................... <br /> PHONE ._......................................................................................... <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details .....t���� '�U <br /> New Building .......... Type of Construction: No. Bedrooms ....�.. i <br /> Addition ._.....,., ,,,,,,,,,,,,,,................................. Septic Tank Size CSIs. <br /> Sanitary Size ft. x ft. ��tSCC"y_ C>i <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .. __. AreaSoil <br /> ........................................... yP ........ .n... <br /> Grading Slope ....&74..... ° <br /> .... ................. <br /> Mobile Home .......... 3. Use escribe exact) -family Perc. Rate .......t... ................. O <br /> Privy ,,,,, om arage, motel, etc. Dry Well .......... <br /> ... i <br /> Well Seepage Trench <br /> .. .................................................... ..... <br /> Subdivision Privy ... <br /> .. .. .... . .... ... <br /> _____ __. _ Seepage Bed X /� #' '�i <br /> — o m <br /> ocalion of p orr,sd cl r c.: and e istin 1 strur tui rar II eW'lge systr rns roads etc should b_ ske-tched in Fig. A. Include road r .fr. <br /> Q } <br /> et hack, side and brl track ya dimension and locatron and se-tback from all bodlc-s of water II property is located at a highway inter- �N <br /> section, show the inters ting highways and the sntdacks required along them and at the inters Nation. CLEARLY LABEL EXISTING rw < <br /> STRUCTURES AND PROPOSED STRt1CTURES AND ADDITIONS. lvl <br /> ---------------------___— —__--------__— _________________________ 1" <br /> Fig. A. 6. Location {; <br /> 5. Lot Size: �j J <br /> ................ ft. x .............. ft. . ................C .Iti sq. ft. ` - <br /> r., a <br /> C <br /> v= A <br /> -�- �— Oo0. <br /> s <br /> l T <br /> J] <br /> I � <br /> q <br /> 41 <br /> so o— <br /> (J fJj 7 3 < <br /> N N d d< <br /> O m <br /> Z 05 <br /> P <br /> (� <br /> aa <br /> Signature of Owner or nt Date <br /> Remarks .... ....6... <br /> «.Z::-�`.L`. x A <br /> ............................ . ...................................................................... o <br /> .................................................................. <br /> .......y............................................... <br /> Inspection Date ........`..:�........................ <br /> ....................... ........... . . � o o o o o o m <br /> Zoning <br /> Administrator 0 0 0 0 0 0 In <br /> NOTE: A preliminary site inspection must be made and site approval granted oil all stutctures involving sanitary t,ic ilitiaz <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must Iso attached to <br /> this application before a perrnit 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 illy of the information cnnveyed here <br /> with is found to exist. Changes in plans or SpecifiCatlons Shall not be mode without approval of the Zoning Atlministratwr <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />