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BUrnctt County Office of Zoning Administrator 3 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> :o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < Z :d\ <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 e (/� •� <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a alb <br /> .FF <br /> �. 4Y. tf/; Y 1�1�!1 �+.r.ff'SSe �f S %P�! Y¢c S7' y f <br /> .................... <br /> OWNER Iplease print) CONTRACTOR or SURVEYOR or AGENT c CD <br /> ADD RE. o � !=hRYe So.. <br /> ............................. <br /> SS <br /> ADDRESS °+ <br /> ............ <br /> ADDRESS ADDRESS <br /> ............ <br /> ........................................................................................... .P.... ....................................................................... <br /> PHONE HO..NE.. <br /> N..Y.l�tl.. s4.�[r o�! .. ...................... ............................................................................................ `\� `•. <br /> PLUMBER S 4o, �'O / WELL DRILLER <br /> .. . . y <br /> ADDRESS ADDRESS <br /> !`y <br /> M o <br /> ........... o' <br /> PHONE PHONEZ H <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms / <br /> .......... <br /> New Building ✓ Type of Construction: <br /> No. Bedrooms .....� o <br /> AdditionSeptic Tank Size Gals. <br /> Sanitary ...`....... Size . ft. x ..rV...(7..... ft. ......•••• i O <br /> Filling .......... Height............. Stories ...L.......... 4a. Absorption Field Site: i <br /> Moving ......... Area ........................................... Soil Type .................................... r <br /> Grading Slope .......................................... ° <br /> ......... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate .........=..3................ <br /> Privy .......... home,garage,motel,etc.) Dry Well .......... E i <br /> WellSeepage Trench .......... i <br /> ................................................... E i <br /> — Subdivision Privy <br /> .......... ............................................. ...... i <br /> Seepage Bed x.... <br /> ------------------------------------------------------------- cn <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road Q, c <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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. y :\a <br /> ---------------------------------- ----------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: i ?� <br /> ................ ft. x .............. ft.— ............................... sq.ft. ............................................................................... <br /> 3 <br /> t0 <br /> Ni <br /> :Zb <br /> 7 <br /> -n :� <br /> Z <br /> O <br /> d <br /> A <br /> p O <br /> Z 00 <br /> 0 _ <br /> fA _ <br /> m <br /> W <br /> ! ...v. ....... .......... F. $3 10 p <br /> ignature of ner or Agent Date — <br /> X i 7J <br /> Remarks... '! Z�+. .`..:...... .............�'�^......S�r4.��:�%�.".`.�..�....................................... � i 0 <br /> ..............�• ... ...:...0........................................................................................................ t� <br /> �.....!-t../.....6��. .......W.!-�...................... ....... .................................. Y1 E E <br /> 9........... <br /> Inspection Date ...vim.....^Z y_ � o l0 0 0 0 0 0 cNn PTr <br /> ...... ..... . ............... ............A..4.............. 000000rr <br /> Z-2 Adm istrator 0 0 0 0 0 0 t/. <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> Wore 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 if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NO BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />