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Burnet county Office of Zoning Administrator a) a' o 0 <br /> ` APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITDJ . o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as i• n -h <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co ' <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. i o �j <br /> D a • 1 <br /> .� � SEGS c — o <br /> OWNER (please print) ,, CONTRACTOR or SURVEYOR or AGENT <br /> / 3o � . m m s:, <br /> AD/4'o -Cb� (.c1 C ADDRESS 5`2n <br /> ADDRESS ��/ ��� I (�o ADDRESS <br /> PHONEa T PHONE • <br /> (2 - 778 (79/ 7 Wo,e,/4 i r-.)• <br /> PLUMBER WELL DRILLER W P <br /> 0 <br /> ADDRESS ADDRESS n o) <br /> r+ <br /> o .4- <br /> PHONE <br /> 4PHONE PHONE H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ,,,, 3 <br /> New Building Type of Construction: No. Bedrooms Q. co <br /> Addition V c Septic Tank Size Gals. <br /> Sanitary Size ....../. ft. x .../.d I ft <br /> Filling Heightr Stories 4a. Absorption Field Site: <br /> Type <br /> Moving Area Soilo <br /> Grading Slope r* <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate C'' <br /> Privy home,garage, motel, etc.) Dry Well �4i. <br /> Well JR .C. g_Qa'YN Seepage Trench S�. <br /> Subdivision Privy I <br /> Seepage Bed ' �/� <br /> ( � cn �' <br /> Location of proposed structures and existing structures,well,sewage systems, roads, etc.,should be sketched in Fig. A. Include road `,I 5- ç <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- l,., a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING I <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o' • <br /> 1 <br /> 5. Lot Size: Fig. A. 6. Location: Uj <br /> rf <br /> / Q0 ft. x .>S'SU ft. — sq.ft. <br /> 6 c <br /> co <br /> NO' <br /> O 7 <br /> 7 <br /> co <br /> // 1 o <br /> 3 <br /> 1' z <br /> z 2 <br /> / 4449P X32 <br /> 0 <br /> Vo47R4,4e / • Do <br /> m <br /> �� � <br /> S.T. <br /> (/` <br /> JT <br /> / Do cnr -o* cncoz <br /> m, NQQ< — r+ o_ � <br /> -O CT! ZC d O' 0 <br /> .-+ O H H < co * rr <br /> Z OO' m co X! <br /> s! •0 O <br /> 01 <br /> C <br /> Signature of Owner or Agent Date / ° — <br /> Remarks .A�S tiG�� L Ce Na/Ice- „ x rrrr <br /> CD C <br /> OII • ,1 <br /> Inspection Date 13:2- l��..'e.e9' Ifo o O 0 O cr rT <br /> Zoning Admin' trator o 0 0 0,0 o V <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 he 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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />