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Burnett County Office of Zoning Administratord 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> < :XJ <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and to ated as H o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lend Use C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis nsin. 3 n <br /> r)01- d o <br /> ......................................... .. .............................................................. .. <br /> ........... �......... y <br /> OWNER (please print) UIn 61Al1A 1= NYNS.4A ,GDNTRATOR or SURVEYOR or AGENT �AN$��� <br /> ....N.o(/.arvR�rCCesoc�`�. .w.....bst.ei ........ O� <br /> ADDRESS ADD S <br /> ADDRESS ADDRESS <br /> ........... fe w..ta.....syy� <br /> ............................ <br /> PHONE PHONE ri <br /> ............ —.............................. <br /> .......................................................................... .......... <br /> PLUMBER WELL DRILLER <br /> ....... . ................................................................................ . . ............................................................................ .......... � ' <br />' ADDRESS ADDRESS C) <br /> PHONEPHONE. . ......... ............... ........ ..... . ...... ..... .... ..... .............. ..... ...... ... ....... ....... ........... .......... <br /> DESCRIPTION 4. Sanitary Z oo� <br /> a.r+ <br /> Iii 1. Work: 2. New Building Details No. Bathrooms o ` <br /> New Building .......... Type of Construction: No. Bedrooms .......... [ ` <br /> Addition ...,.,,... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size.. .............. ft. x .............. ft. .......... <br /> FillingiGrading „ ,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area . . . . .. Soil Type ......................... .......... o <br /> Mobile Home ..... .... Slope ............................... .......... .* <br /> Privy ... 3. Use (describe exactly, 1 -family Pere. Rate ........................ .......... <br /> well .......... home,garage, motel, etc.) Dry Well .......... i <br /> Subdivision .......... ....................... ..4......................... <br /> Camping Unit Privy ..........Seepage Trench l <br /> .. <br /> Seepage Bed .......... <br /> ------------------------------------------------------ -------- --- w <br /> Location of proposed structures cru res and existing structures, well, sewage systems, roads, eta, shoultl he sketched In Fig A. Include road O <br /> Q <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property is l—oca—td—at—a— <br /> ed at a highw y inter- o- <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection <br /> CLEARLY LABEL EXISTING N o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O' <br /> _ _ 3 <br /> 5. Lot Size: L� S Fig. A. 6. Location: <br /> ................ ft. x .:............ ft. — ............ sq. ft. ..............................................................................i;.4r E <br /> OO <br /> �I Y <br /> Y <br /> T <br /> ^ rL W m <br /> c(✓l� Q E I O <br /> J � <br /> ri X 1l <br /> a'°2 , <br /> �rtUy �" blQ�� <br /> < m ? F <br /> m sa O n <br /> I 42 � <br /> O ' n <br /> Z 06 n <br /> _— o <br /> cn <br /> {j fs�l <br /> ... ................6en*......................... .... ...................................... <br /> Signature o caner or Agent yGq� Date <br /> Remarks .........D4!NP! ./.."........ ...4,/�....G.�nii a t�-P �!^r er.. /-•o. ,J T x m <br /> A i�/d 11 <br /> s. ... .....................s ....................................................... ....... _ <br /> ......... ........ ................. ............. ....... <br /> Inspection Date ....................................... ... !�”/... ..! rn Pi to u, <br /> w <br /> Zoning ministrator <br /> NOTE: A preliminary site inspection must be 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 percolatioi test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any pl mbing or start any build <br /> Ing until a permit has been issued- A permit may be revoked if misrepresentation of any of the in orm ation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of tte Zoning Administratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE iAND APPROVED. <br /> illi <br />