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Burnett County Office of Zoning Administrator iu o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < m -^ °O <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n :S <br /> E . �. ....1P.. ..w... .0.,.✓........................ .........P ,o..f.....�'•�a.. .................................... N <br /> 0 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> /e.T.....(........... <br /> �Q.ax....../...S�.G............................ ........��A��/Qt� .....�f// ....... ........... �U <br /> ADDRESS ADDRESS + <br /> I�/.JTaC.K......1�//.s..�.......! l��'�. ............................................................................ <br /> ADDRESS ADDRESS <br /> .. 4�!...... 4 ;V.�.r......................................iii 6 <br /> PHONE PiovE \ Y1 <br /> .............................................................................. } <br /> PLUMBER WELL DR U <br /> I LLER i <br /> i <br /> ADDRESS ADDRESS n O <br /> c r <br /> ........................................................................................... .................................................... ..................................... o .: <br /> PHONE PHONE Z H m <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> """"" o <br /> New Building No. Bedrooms .......... i <br /> Type o Construction: r� <br /> Addition � LtJ��-» Septic Tank Size Gals. Q <br /> .......... ..............�f./.R..frt. Xi................. t. .......... � <br /> Sanitary .......... Size ....w�. ft. x .....,w'�..G ft. ... ' <br /> Filling)Grading Height............. Stories ............... 4a. Absorption Field Site: <br /> Soil Type ..................... rMoving .......... Area ........................................... <br /> o <br /> Mobile Home Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pope. Rate ................................... p <br /> Well ....,,,.,, ho ,garage otel, etc.) Dry Well .......... <br /> SubdivisionSeepage Trench .......... <br /> .......... .................................................... <br /> Camping Unit .......... Privy .......... r . <br /> .................................................... Seepage Bed <br /> .......... W <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched In Fig A. Include road p' <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter � a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING t <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Q o� <br /> __ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. - sq.ft. ............................................................................... <br /> O <br /> m <br /> n <br /> N O <br /> o <br /> 3 <br /> �l o <br /> v y <br /> � z <br /> t a <br /> ` z it <br /> rr O <br /> a �� O <br /> G ` N <br /> r <br /> o „: � <br /> a : yam <br /> Z <br /> 0n n ' <br /> on - ° 3 <br /> o <br /> Signature of Owner or Agent Date I — <br /> X <br /> RemarksS'&'.L ti... .a..3.o.............................................................................................................. .n O <br /> m <br /> rn <br /> ........................................................................................................................................................................................ — . . . . <br /> y, II <br /> ...................................................................................................... ... V <br /> 1c................ .............. .. <br /> Inspection Date ....................................... ...(.Z!^.Gn .................. ......... ......... ............... <br /> U IF <br /> Zoning Administ ator 8 0 0 0 0VW <br /> NOTE: A preliminary site Inspection must he made and 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 most be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumhing 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 We made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />