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r <br /> Burnett County Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use a� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. lO <br /> ......................... r...... ... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT 0 —{ <br /> i3axi� 9 w€� rr< -: ......s.. .. ..-.:............................................................. a <br /> Re.................................... .................. .. ..,..:........:.., r <br /> ADDRESS �i ADDRESS ;� <br /> !/U. ........ .�1..4..r .a...... . . ... .7....�r................................................................... <br /> ...................................................... <br /> ADDRESS Qp // AD<DRESS <br /> ................X1...4?::.. -..- .Ll>.G\.V.................... ............... ..../..:�..~.../............................................................._... <br /> PHE ...........^.................................................... PHONE A <br /> p XX <br /> PLUM .� <br /> ..LU . .......................................................................................... O <br /> ER WELL DRILLER � <br /> ................................................. <br /> ........................................................................................... <br /> . .................................... <br /> ..... � m <br /> ADDRESS ADDRESS n O <br /> ................................................................. Z <br /> PHONE 7 <br /> PHONE r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° :O <br /> No. Bathrooms .��..... Sl M 'G <br /> 1. Work: 2. New Building Details o i <br /> New Building No. Bedrooms <br /> g „n,,.. Type of Construction: """"" :"' <br /> Addition >< Septic Tank Size Gals. .......... jtn <br /> Sanitary ...T...... Size ,."14-95... ft. x ..�.. .. ft. :�- <br /> /; <br /> Fiuingl Grading .......... Height../..$�... Stories .�..yl7..... 4a. Absorption Field Site: ' E> <br /> SoilType .................................... : r <br /> Moving .......... Area ....$.9.,G.. .................... Q o <br /> Mobile Home ........ Slope .......................................... <br /> ` <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well ..x.... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision r— Ff�M![ y HO M. Seepage Trench .......... ?� <br /> Camping Unit .......... .................................................... Privy .�,{��`. > . } <br /> At. <br /> Seepage Bed f ...�' <br /> ----- ------------------------------ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.r should be sketched In Fig. A. Include road <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 �o = <br /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ' . .n o <br /> __.________________________________ —__ <br /> 5. Lot Size: ............. . Fig. A. 6. �OTOn: p � , t'J .. .� � <br /> ................ ft. x ........... ft. — ... s9. ft. <br /> ..... ...7....JIK.Z.......Al.:.-... .. ... ..S.H... fS <br /> 5',Ks TC fl <br /> eco r,e�ak-�l/ > <br /> ? <br /> 3� `' oust GDS / w`� qfu o <br /> 32 <br /> FO G- ! i 0 <br /> � ! ro — c . d <br /> o n N w e <br /> m <br /> o oE : a � 70 <br /> TM <br /> Fid C- v /! � rn '_ � <br /> L F1 K t= r s <br /> �.-.tee..... �o z <br /> ET i <br /> Signature o�/floor-Agen t Date <br /> Rem ar �fj f� f—ETZ- . . ............................ . � x O <br /> ............ . . . /.,........................................................................ <br /> /j ,Z¢�.. c�. .(....`_...71� ?f/ G% �� �cl ................................................................... <br /> M . . . <br /> ................. .. ................................................................ . <br /> II <br /> � : <br /> Inspection Date ..L.�..:'./:' .`.�........ ..... ....... ._.............................. : 8 a o 0 6 ;. m <br /> ..................... ......9... .............. ... <br /> Zonin Ad nistrator F ✓ : 1 : 8 8 8 0 00 to <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 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 NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />