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Burnett County - - Office of Zoning Administrator d o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT '' tto <br /> - o :� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as no c <br /> shown herein. The undersigned .sees that till work shall de done in accordance with the requirements of the Burnett County Land Use <br /> Dramatic.. Sanir oem Cede,and with all other immiscible County Ordinances end the laws and regulations of the Slate of Wisconsin. 3 2 <br /> ..:.'......5..(:...41._�.�_s..S... ...._ d o <br /> OWNER Iplense stunt CONTRACTOR ar SURVEYOR or AGENT , <br /> la..y.9.O...I=.X.C.e..S..S.(..o..V..'......f0...9.............. .........s...saw.. ..n. ?..Y.......................__...................... <br /> ADORESSADDRESS <br /> ADDRESS ADDRESS � O� <br /> .......................................... ................................................ ..........._._._........................._...._................................:...... !lJ `!tea` <br /> PH//OyyNE �7 - PHONE b <br /> ..L+.. ?..... ......W.......l..I:f../.t.�S.A.d�...................... ............. . ............................................................................ `C <br /> 1 <br /> PLUMBER WELL DRILLER <br /> yl3_.... .^ .Lh....S._...... ................... ` <br /> ADDRESS ADDRESS m o v�� <br /> 435 .. o s <br /> ..... ..................^................................................................. ................................................... ....................................... ' <br /> PHONE PHONE <br /> DESCRIPTION 4. SanitaryFacilities: <br /> 1. Work: p. New Building Details No. Bathrooms ....!. o ^ <br /> New Building Type of Construction: No. Bedrooms ...... J <br /> Septic Tank Size Gals. ..7.':76 <br /> Addition .._. .... ....._............................_............... <br /> Sanitary Size ._'1..:f.... ft.x ..",�..7.,... ft. i r <br /> Filling .......... Height...:......... Stories .... 4a. Absorption Field Site: <br /> Motrin .......... Area ......................................... .✓✓ <br /> Soil Type .................................... r <br /> Grading <br /> Sit <br /> Mobile Home ....... 3. Use (describe exactly, 1 -family Perc. Rate ........................../...... ti <br /> Privy ......... home,garage, motel,etc.) Dry Well .......... [ <br /> Well .......... I.o .!............. Seepage Trench .......... i r <br /> ......t�...... ...f[.r{.1... . <br /> Subdivision Privy ..._... . <br /> .......... ........................................ i <br /> "--- Seepage Bed .– D� <br /> Location of proposed structures and existing structures well sewage.systems,roads etc.,should be sketched in Fig. A. Include roe LU .is' ;\ <br /> setback, side and back yard dimension and location and setback from all bodies of water. if property is located at a highway lure Q a <br /> section, show the intersecting highways and the setbacks resulted along them and at the intersection. CLEARLY LABEL E%ISTIN <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. --- -- -- --- -- -- — ------ <br /> -------------------------------------- <br /> 5. Lot Sizer Fig. 6. Location: <br /> t. <br /> Gis <br /> N r <br /> ce A <br /> re <br /> de <br /> �1 <br /> N <br /> � I <br /> re <br /> as <br /> � I <br /> I <br /> v _.C ; � � <br /> Z o0 <br /> o = <br /> as <br /> Ft <br /> Signature of VWLcr or Agent Date — <br /> x b : S <br /> Remarks ........................................................................................................................................................... re m <br /> . :, : �: <br /> o <br /> der <br /> ................................................................................................................................................................................ ....... <br /> ;biV II N T <br /> an <br /> Inspection Date ................__....... ....._._ .A!,7I1�� / 7 LTJ : I�: OOO per <br /> O O ceo O O <br /> ZoringAdfninistrator o peo o a o u <br /> NOTE: A preliminary site inspection nlusl be made and site approval granted on all struCmres involving Sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy at the percolation lest must be "NoChed to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start on, build <br /> Ing until a permit has been issued. A permit may be revoked If n slepre Hinoti°n of eny of the Inlormlrl ion conveyed herr J <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 INSPEC'CED BY `IIIS OFFICE AND APPROVED. <br />