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County Office of Zoning Administrator <br /> 0 <br /> APPLICATION FOR`SANITARY — LAND USE — BUILDING PERMIT <br /> o :\ <br /> : ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> nerein. The undersigned agrees that all work shall be done in accordance with the regciremects of the Burnett County Land Use m <br /> ince, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> a O <br /> ..He1m%'r..An n90n................................................... ............................................................................................ <br /> ......... <br /> iNER (please print) CONTRACTOR or SURVEYOR or AGENT _' '.z m <br /> o <br /> .............................. .......................................................................................... <br /> aDDREssADDRESS <br /> ADDRESS . .......................................................................................... <br /> ADDRESS <br /> PHONE1.5.....3. .9r.5.2Q' ................................................... PHON.E................................................................................ <br /> L <br /> .. ....Donald..Daniels................................................... <br /> PLUMBER WELL DRI LLER �i� ZQ <br /> .......Box...W.....Siren.,...W2..5?1.872................................ ...................................................................................... <br /> .. _o <br /> ADDRESS ADDRESS <br /> . . .................7..1.5.....463.-2333..................... . .......................................................................................... <br /> —^. < <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms 1U <br /> 2. New Building Details ...... <br /> Type of Construction: No. Bedrooms 0 <br /> New Building <br /> 3..... Ry <br /> Addition .......... ...... Septic Tank Size Gals. 1000• V <br /> Sanitary X..... Size .............. ft. x .............. ft. <br /> FillingHeight............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type ........................ ........... <br /> Area µ <br /> 09 r <br /> GradingSlope <br /> Mobile Home .•.......• 3. Use (describe exactly, 1 -family Perc. Rate ....4............................. ' <br /> Privy ........., home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench <br /> .......... .......... 0 m <br /> }� <br /> Subdivision Privy m <br /> Seepage Bed ..X..... m <br /> ---------------------------------------------------------------------- .) e+ to <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road 4� it non <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway ir-er- °✓ 0 _a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY I.-ABEL EXISTING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ------- <br /> 5. Lot Size: . <br /> .. <br /> ft. x .............. ft. — sq. ft.t. 6. Location ......... .... �' z <br /> r� <br /> N <br /> O j <br /> 7 Lo <br /> O <br /> toN <br /> S <br /> j; <br /> z <br /> o <br /> 0 <br /> cn r cn z <br /> 'O of G. C : m � � <br /> z Vl N : '< M <br /> O <br /> C) 3 _ <br /> : . � _ <br /> o <br /> ­l <br /> . re o <br /> M <br /> 3i atuf Owner r Agent Date ° p <br /> Remarks .. X <br /> ....................................................................................................................................................................... - m <br /> ....................................................................................................................................................................................... : 9: <br /> ffl :IU, <br /> i� <br /> nspection Date ....................................... 0 0 0 o ccr, m <br /> Zoning Ad strator 0 0 0 0 n 0 <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facililwc <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> tis application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any huild- <br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BF COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />