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/71'11)-ir 11 <br /> Burnett County Office of Zoning Administrator iu --1 0 <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 •� ,n :� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n v <br /> ...^.0�...`.�....... "e ..�.�14.......................................... . .......................................................................................... H w O <br /> /� n <br /> OWNER (pleas print)• CONTRACTOR or SURVEYOR or AGENT m <br /> a <br /> ADQ..4.!L... .C. :±!'. ..........W.1..1.................................... . ...ADDRESDRESS.............................................................................. : <br /> DRESS <br /> .. <br /> ..... . . . ........................................... ................. ... . .......... <br /> . .. . . 4 <br /> ADDRESS ADDRESS ;H <br /> ........................................................................................... <br /> PHONE ? � iy <br /> ... Q. .'.A.f.K................................................... ... . . :s <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .ADDRESS............................................................................ � <br /> ADDRESS <br /> O g <br /> ...... .................................................................................. » < <br /> - 2 <br /> PHONE ............................................................................................ �Z N ,. <br /> PHONE <br /> DESCRIPTION 0 <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> New BuildingNo. Bedrooms .......... :O o° ' <br /> .......... Type of Const tion: <br /> Addition .......... ...... ,,.X/.s...t..j.. .................. Septic Tank Size Gals. .......... :� <br /> Sanitary .�„ Size .............. ft. x .............. ft. <br /> FillingfGrading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type ............................. ...... •r <br /> Mobile Home .......... Slope .......................................... <br /> o <br /> Privy ....... 3. Use (describe exactly, 1 -family Pere. Rate ................................... J E <br /> ... .,........ ) � ' <br /> Well ......•... home,garage, motel, etc.) Dry Well <br /> Subdivision Seepage Trench ........ r. <br /> ZIP <br /> .................................................... <br /> Camping UnitPrivy <br /> ,,,,,,,,, <br /> .................................................... M (/ <br /> --- ------------------------------------------------------ <br /> ------------ ------- - Seepage Bed l � <br /> ----- /..!. ..b <br /> -------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,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. If property is located at a highway inter � :� Or <br /> t?; <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. <br /> 1fS,C .,7 °tl° : 5 <br /> ---------------------------------------------------- <br /> --------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> f1 <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... 1 <br /> N r o. <br /> 0 <br /> ate : 0 <br /> a: <br /> N <br /> Z C <br /> O c <br /> N <br /> m <br /> e <br /> Z <br /> -O on C m o <br /> m <br /> Z O O D <br /> o <br /> b <br /> �............. ..............1............................ ............... .... ................. C <br /> T <br /> ml <br /> m <br /> .D <br /> Signature of Ow r or--{�A�,ygent ate. <br /> o <br /> Remarks ... . ...C�7J'�`„ m m <br /> e» <br /> ........................................................................................................................................................................................ _V <br /> ............................................. . H <br /> Inspection Date /�!..`o'�6.. BJ.......... 1..... :Ig N m N m <br /> ov ou o � m <br /> Zoning Administra or $ $ $ $ $ $ H <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 />