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nett County �� Office of Zoning Administrator d M o{I( o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d o <br /> PHE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as ; " 1 <br /> n herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m 10 <br /> lance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> C' G _ 01 <br /> X. ....1' ...-..C'. ..L..r................................ ............ ..........C-.........-7. . -................................... N <br /> iER I ase print) Y / CONTRACTOR or SURVEYOR or AGENT a np \ <br /> .................... . .................................................. . . . . ............................................................................ as <br /> RESS �DD . - . • <br /> ADDRESS <br /> Wb.b......L....�.�r . ............................................. . . . . . ................................................................................. <br /> RESS ADDRESS <br />.......... .......s...q...........y�. .:................................... <br /> VE .PHONE................................................................................ <br /> i E <br /> _`, ............................................................................................ <br /> v18ER WELL DRILLER <br /> RESS..... y. . .......................................................................................... � m 09 ADDRESS <br /> 0 o <br /> c <br />.................................................................................... . ..... ................................................................................... o <br /> VE PHONE.. Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 2. New Building Details ••••.••••• '��Q\ o <br /> lurk: No. Bathrooms <br /> ew Building ...A... Type of Construction: No. Bedrooms .......... .�:AS 0 <br /> ddition Septic Tank Size Gals. ....... t� v0 <br /> anitary .-'X... Size .UX11;Lft. x .............. ft. .......... <br /> filling <br /> 4a. Absorption Field Site: <br /> •„•, •••• ............. tories ... .......... r�i i; <br /> rloving .......... Area 1-41.7.. . Soil Type .................................... i <br /> radin9 .......... Slope ................. ........................ <br /> o <br /> lobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> rivy ,......•,• homey�a�ra III, motel, etc.) Dry Well .......... <br /> �/ '� <br /> ILI <br /> sell ... ... ................................ Seepage Trench ....... .. �. <br /> ubdivision .. .... . ....... Privy .......... <br /> .......... ............................................. <br />------------------------------------------------ Seepage Bed <br /> ------------ <br /> tion of proposed structures and existing structures, well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road I c <br /> r <br /> ck, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- �” rro- <br />,n, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING `-: <br /> JCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Qn.. o°• <br />--------------------------------------------------- -- — t{ �. <br /> ct Si 80 q 6�S— Fig. A. 6. Location: va <br /> 7 — — ---- <br /> ----- <br /> ........... ft. x ...3........ ft. — ....R. ............r.2.. sq.ft. ............. ..................................... .......... <br /> ` P <br /> `.J N <br /> 0 <br /> 02 <br /> N o <br /> -37 <br /> o `C. <br /> 17 <br /> o <br /> V: <br /> m :C <br /> Z <br /> X <br /> 7 <br /> b <br /> 0 <br /> =. <br /> fa <br /> Z O O <br /> N 3 _ <br /> O : <br />,ture ofner o gent Date _ <br /> .VC A G� ZJ`�d x `: M z <br /> irks . <br /> :n: m <br />............. . . ................................................................................................................... <br /> ..................... ;.. <br /> ction Date�G! :5_- J.............. .�.. i�?CO../`;,.... ".....^ ......... jd o o O o ul m <br /> Zoning Admin strato�r 0 0 0 o o to <br /> 1r.y............... 000' oom <br /> A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> e construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> Pplication before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> ttil a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />