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Burnett County," - Office of Zoning Administrator w o 0 <br /> P <br /> -APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3: o O <br /> TO THE ZONING ADMINISTRATOR: The oadersigned hereby makes application for 9 Permit for the work desvibed dna Increasers — W <br /> q <br /> shown herein. The onrlCode, tl agrees that all work shall hedonein Ordinances <br /> with the requirements of the Burned Coeofy Isco Use <br /> Ordinance. Sanitation Code,and with all Otho!applicable County OrtlinanCPs antl IM1P laws and regVldtons Of the State Of Wisconsin. <br /> ....... <br /> a.v_ t................ ........ k <br /> n : <br /> OWNER InICase print) - CONTRACTOR or$URVEVOR or AGENT n <br /> ar <br /> ADDRESS ADDRESS <br /> .............................................. ........................................... . ...............................................:........................................ <br /> ADDRESS ADDRESS - � <br /> ..........�......�.................................... ...._.___....... . ......................... .................................................................. <br /> t. .O <br /> PHON • t { �',J , ......._......._. PHONE - <br /> ........... Qf�....''1.1' . ...0 �..�. .5.............. ..............................................................._.........:................. i, :N <br /> li <br /> PLUMBER , .- - WELL DRILLER - ti t � ,� <br /> .1. �3c�. ............_...............:......................_.._..................._._........ <br /> AD <br /> DRESS .:...54. ADDRESS <br /> .:.c_2`Lel.....:3..Sa`1..._..._........: ....... . .. N a J5 <br /> o _ <br /> PHONE PHONE <br /> Sanitary <br /> 01 <br /> Details No. <br /> 1. New Work: illd n9R IPTION 2 Type ofNew llConstrruction 4 No. <br /> . Bedroo Sive Gals. .$ . :� ; � I <br /> ` X11 II <br /> Sanitary ..A.. Size ..........._- ft.x ......_...... ft. <br /> Filling ...I...... Height—.......... Stories _......_...... 4a. Absorption Field Site: , <br /> Soil Type . ........ ..S...l("Area ... ..... ...... ...a_[).:....6.0/6 <br /> .. <br /> SIoPe ......_......Moviny �e/QGrading .......... <br /> or <br /> .. <br /> .......... . : <br /> Mobile Home - 3. Use (describe exactly, 1 � familyPere. Rate ........ <br /> Privy ..... home,garage, motel, etc.) Dry Well .......... <br /> Well .........1. .............. ..._....._............... Seepage Trench .......... i� <br /> Subdivision '.Privy ......... <br /> .......... ....................:...........I.............._ .. Seepage Bed ar-F35.... ILA <br /> V 1 N <br /> Locati6n of Proposed structures and existing structures well sewage systems, mads 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, It doesenty is located at a highway inter _ <br /> section, show the Intersecting highways and the setbacks required niche them and at the intersection.-CLEARLY LABEL EXISTING c 1 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 1 o l <br /> __________________,_—_—__—_---_--_---__—__—__---_—__—__— <br /> n <br /> 5. Lot Size: � / Fig. A. - - - Z• r 1rr' <br /> .....F(5.... ft. x rl.LJ... ft. ,. ft. <br /> IfI <br /> Ira <br /> If I <br /> S <br /> Ilz<` IZ <br /> O a <br /> • i i �e I <br /> iV\ <br /> q �• c•r�9A m) <br /> mets. �:` I <br /> N 'i` E.� <br /> ... ....... . <br /> �IFt�Syw ter Ageni <br /> Date - - - . <br /> Remarks;..©1.L.FCi�._ .7 J'E�1.:.... .........._._._._._.................. ................_.................... ......_:... .��,.........'m ,t <br /> ..:............ .tLL� .�.�.. :fLCLE.LGN.:........_._ <br /> ...................... <br /> ....:....:......................................... <br /> ._........:_......_ PH — <br /> 1 <br /> ........................................./........................................:.............. ............... . .... : ........................................:................�...... <br /> Inspection Date .. ..fv..-.�.p.Z..... a.:..!{..:.d1...... ..^... .^.^'.............. . ........ sibi l <br /> 1e <br /> Co0o <br /> Zoning Administrator 0 0 0 0. <br /> NOTE: A pre tial inzry site inspection must he made and "Inarmee l granted on all vnretmes involving sanitIf <br /> ary. faiilitics� <br /> before construction can begin. In the case of sewerage disposal syslenl9, a copy of the percolation test must be attached to <br /> this application before.' a permit will be issued. Do nor purchase or install a septic tank, do any plumhing or stall any Build <br /> -, <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of;I•ny of the information-conveyed h 'eire-� <br /> with is found to exist. Changes in plans or specifications ShIUI not be made without approval of the Zoning Adm nislrato . <br /> ar <br /> SEWER SYS EM SHALL NOT BE COVERED UNTIL INSPECTED ByTHISOFFICE -AND APPROVED '' 1 <br />