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Burnett County Office of Zoning Administrator d ✓✓� 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �' 3 <br /> v <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for th work described and located as '� - o J <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the re remen o he Burnett County Land Use c � <br /> Arinye, Sanita ion Code, and with all other applicable Coun sand the laws a regu do sof the State Wisconsin. a Q..� o.C .!�1. �. Y1 ........................... .... ... . .. ... .e:�.... a o` <br /> OWNER (Please pri CONVRACTCO r S VEY rAGENT m1 iirBtB�F <br /> Ao. S ........ ... ..... P.cp.v�e ...W.�s , <br /> AMR <br /> RESS 't)M.�. .. .Q.V1........m,.\L1�.1�. SS <br /> .......... , sl..........�,"•1.�....A.........J..�1..31.<...I...... i { •� <br /> 62313:__7 2�. .�...................................... <br /> PHONE PHONE <br /> ........................................................................................... . . . ..................................................................................... � <br /> PLUMBER WELL DRILLER :! <br /> ........................................................................................... .A...... . . ..RESS............................................................................. p <br /> ADDRESS DD <br /> ^. < <br /> n o <br /> PHONE PHONE <br /> DESCRIPTION n o <br /> 4. Sanitary Facilities: � o <br /> 1. Work: No. Bathrooms .......... 3 i <br /> 2. New Building Details it. <br /> New Building T e of n ruction: No. Bedrooms .......... F <br /> t <br /> Addition ..k.••• ; • .............''.tt�•••`7••••• Septic Tank Size Gals. .......... <br /> Sanitary ..... .... Size .1(v. ... ft. x ..�Z.r.].. ft. .......... <br /> Fillingf Grading Height $tpr' .....I........ 4a. Absorption Field Site: <br /> Moving .......... Area <br /> . .s ......... p Soil Type ................................ ... 4? r r <br /> o <br /> Mobile Home ..... .... Slope .......................................... � .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Dr Well CC fn� <br /> Well .......... ((.1l garage, mot") <br /> y .......... v 1 <br /> Subdivision .......... p Seepage Trench .......... <br /> ... �l. .... . ......... . ...... <br /> Camping Unit ......,,.. -?W-A • I=N.. Privy .......... <br /> _______ <br /> Seepage Bed <br /> ____________ C � <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- 0 a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING O <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. - <br /> _____________________________________ y<� <br /> ___________________ II <br /> 5. Lai-Size, Fig. A. 6. L ory ' <br /> .. ,.., ft. x ..�..,� y ft. - . sq.ft. - . . Aq L\.a19.1/.\.....( �-'1..�,....................... S <br /> m <br /> IN /� o <br /> 0 <br /> s <br /> r"� <br /> o Z <br /> 1 1_ 7c: <br /> WW1 <br /> ` it I cn ryrn m z _ <br /> M <br /> cr <br /> � m <br /> M IQ(A <br /> — m n m <br /> (n e m ,� ro a 'O <br /> Z i=I _ D n 171 <br /> O na . M <br /> 90 3 <br /> Lq o 0 <br /> 0,, <br /> � / c�L/.1v.... .e fLel .......�..:. R77:L7.�.. m Ownegent Date ° C <br /> X 31 <br /> Remarks ......................................................................................................................................................................... m m <br /> �^ v <br /> 0 : <br /> ........................................................................................................................................................................................ = : : <br /> II <br /> T. ................................. <br /> InspectionDate ....................................... .... ..... . ..... ............ ........... : <br /> : 8 <br /> ,n ,uNr m <br /> oning inistrator <br /> . 8 8 8 8 in <br /> NOTE: A preliminary site inspection must be made a 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 fie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />