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Burnett County Office of Zoning Administrator �' e <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3• 19J <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 0. <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 d, <br /> regulations of the State of Wisconsin. © ! c. <br /> kyr Vr4• SP43 S <br /> /f fG �f �"A >n <br /> .... ..... ... ........................................................ .. ...... ........................................./y-• <br /> OV N (please print) v CONTRACTOR or SURVEYOR or AGENT » <br /> 1 .. <br /> • <br /> ADDr'S.S..... <br /> SO <br /> ............K ................................................ ........,......................................................................... .ADDRESS a <br /> � <br /> � <br /> '• <br /> PHON ................................................................................ .PHONE................................................................................ <br /> .. A �.h.S....................................................... ..................................................................................... ...... <br /> PLUM QR & afr ra WE LL DRILLER <br /> ADDRESS ADDRESS c r. <br /> .. ........................................................................................ . . . . .............................................................................. ..... r� o' <br /> PHONE PHONE t (1 Z ° r <br /> DESCRIPTION 4. Sanitary Facilities: ,P o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details p _ <br /> New Building ,.,,�� Type of Construction: No. Bedrooms .......... .� isD <br /> Addition !`p!n Septic Tank Size Gals. `1 <br /> ......... ...... ..... ....r.... ,� '�• ? <br /> Sanitary ..{,�„ Size ....� ..4... ft. x ...`.'1....�.... ft. .�..d <br /> Filling/Grading .......... Height.. ....... tortes ............... 4a. Absorption Field Site: . <br /> Moving .......... Area Type .................................... i o <br /> MOEIIe Home .......... SC T Wt•ti•. Slope .......................................... ^ <br /> Privy 3. Use (describe exactly,'1 -family Perc. Rate ................................... 12� <br /> Well .......... home, ara e, motel, etc.) Dry Well .......... m `f.N <br /> Subdivision �1 t/ Seepage Trench .......... Z <br /> ......... ...1.. . . ... . ._..7... .............. <br /> Privy .......... .O i <br /> CampingUnit .......... .................................................... <br /> Seepage Bed /-:'.r-- <br /> :y <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at ;W ...� <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. v <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :O o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: , <br /> ................ ft. x .............. ft. — sq. ft. ................................................. iACCJ� <br /> Ain. ,, ti <br /> 4 N S O <br /> VW 1 1`il\ 0 O <br /> �Oha�f)eS <br /> a <br /> it f <br /> 1 <br /> T o <br /> se4 ���,tte_ to-d-cic <br /> ae �. <br /> 370 <br /> ao Lc�- <br /> D W W1- D 03 00 -0 <br /> m `na — mm � nm <br /> CON <br /> =. : M O <br /> l O D ' 1 <br /> 4411 <br /> x r, <br /> c <br /> 7 -i7 ........... v <br /> Sig <br /> g-of <br /> Owner or Agen Date o <br /> emarks m' y <br /> ............................................................................................ a <br /> m •• <br /> o <br /> ............................................................................................................... ......... .. ........................................ o <br /> 0 <br /> Inspection Date J J N T <br /> ....................................... .... . ........ g ........ .. .. ........................ vt cnrnoocnm <br /> Zonin Ad nistrator 888999 (A <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />