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Burnett County Office of Zoning Administrator c 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <br /> N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Cade, an th all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- <br /> J <br /> AT^J » <br /> a <br /> ..............................................- /�.r'�..3.t�................... ....................!;:e....IF.. N _ <br /> OWNER (pl se print) CONTRACTOR or SURVEYOR or AGENT a <br /> d :� <br /> m <br /> t7J'e ..........W. f... r' <br /> a <br /> ADDRESS ADDRESS ::A <br /> .......... <br /> ........................................................................................... . ............................................................................... <br /> ADDRESS AD.. DRESS A <br /> ........................................................................................... ............................................................................................ <br /> PH ........................................ PHONE <br /> PLU ER �r WELL DRILLER p ' <br /> ........................................................................................... ............................................................................................ <br /> � ' <br /> ADDRESS ADDRESS <br /> » o <br /> < <br /> PHONE PHONE J � ' <br /> r :7 <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> Y. <br /> 2. New Building Details o <br /> New Building .... Type Construction: No. Bedrooms ...�.... : >7 <br /> P' 4 y Septic lank Siz Gals. ' <br /> Addition ......... ...�..�../.r.�............ .......... :<£ <br /> Sanitary �.... ft. x ...7..1�+... ft. 14 t �O !w. <br /> .....K. Size ....... tt <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field <br /> Q <br /> Moving .......... Area ........................................... Soil Type .................................... <br /> Mobile Home .......... Slope .......................................... ? p nL <br /> rrC <br /> ^ <br /> -fami <br /> Perc. Rate ................................... <br /> Privy .......... 3. Use (describe exactly6 <br /> Well ...X... home,garage, motel,hC7 Dry Well .......... is <br /> Subdivision .......... Seepage Trench .......... f <br /> Camping Unit Privy .......... :P <br /> ........ ..... <br /> Seepage Bed ......... <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road cr <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway Inter-section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <7* sst <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ( <br /> iA 0' <br /> ---------------------------------------------------------------------- A_ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. .... /op.3.Q.:3... .9...7.................................. Al <br /> n <br /> N Y O <br /> o :Lq, <br /> J <br /> J � :l� ry <br /> U7 —1I <br /> 0 <br /> O <br /> J <br /> S <br /> 9 <br /> T <br /> Z '4 <br /> o <br /> m <br /> J <br /> m <br /> 1 ' <br /> Cal r � <br /> lfl n <br /> rD N p- � <br /> "O U1 < : ,� 0 c m <br /> Z o o D a <br /> m <br /> � - m3 <br /> o � � <br /> �- - c <br /> 0 <br /> ... ................... .......................................... ...................................... o <br /> Signature of Owner r Agent Date — <br /> X <br /> Remarks TI m <br /> m <br /> II <br /> .......................................................................................................... . <br /> Inspection Date ....................................... ... .. lr o � 'o m <br /> A��rator 8 8 8 8 0 8 to <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faCIIILIUs <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 it misrepresentation of any of the information conveyer) here- <br /> with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />