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Burnett County Office of Zoning Administrator -g4 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITm 3 3 :RSA <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described nd 'Z �• >;`i <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,8 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 /.^> <br /> re/�ulationnss o}ftthe S of Wisconsin. a Z4 <br /> .l...l.�...t.A.t:.. ! ... . ............................................. ..... . . . . . ................................................................. ...... A � <br /> print) � CONTRACTOR or SURVEYOR or AGENT <br /> 0 <br /> �/ ER l lease ...... ..................................................................................... ...... m <br /> AD ESS ADDRESS <br /> •_ <br /> c.............. l <br /> ..................... ............................................. ...... <br /> ADDRESS � ADDRESS K ` <br /> ........................................................................................... ........ .... ......................................... .... —_ <br /> PH E ...........................................-D l�-'1 ] �`V`.-'1 .X� ti <br /> tiA / <br /> k ......... .............. ........... .... . <br /> PT <br /> e � WELL DRILLER <br /> ` \ <br /> �� - ��� ILSo . <br /> R ESS ADDRESS o <br /> 1„II.Vy...Y)! .................�......,,,1 -!,,,........... ............................................................................................ o .. <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o - <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details .. "..... o <br /> �V/ g No. Bedrooms <br /> New Building „-%`• Type��,.�Co/nstruction: .. """' . <br /> Addition t"Y>l(."}L� .... ...... Septic Tank Size Gals. J. <br /> ........ ........ .. .rte <br /> Sanitary „��, Size .,.5.1.1.... ft. x `f...... ft. <br /> Filling/Grading .......... Height....... Stories ............... 4a. Absorption Field Site: <br /> Moving Area .......� . ... . . Soil Type ............................ ....... i o <br /> .......... . . ............. <br /> Mobile Home .......... Slope .................................. ....... - - <br /> PrivyPerc. Rate ........................... ....... m i <br /> .......... 3. Use (describe exactly, 1 -family 0 <br /> Dry Well m <br /> Well ,,,....... ho e,garage,motel etc.) � � � - <br /> Subdivision / Seepage Trench o <br /> . -..!dr ..;7Zt& L .. ....... <br /> .......... <br /> Camping Unit ''��ff/�� - Privy �` :A` <br /> .......... ....... 11/7.!a� ................ op.. ..... . 0 f� <br /> Seepage Bed <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. XJ � C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local 9d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the interseci ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 5. Lot Size: il' - Fig. A. 6. Location: <br /> . . sq. ft. `�- <br /> 0 <br /> N O <br /> � O � 7 <br /> A <br /> 1 F 0, o <br /> ?7 <br /> 21 <br /> Z <br /> — o <br /> r <br /> d <br /> vivmr awm � <br /> 3 � »Q < > > .0CSm <br /> .�-, m N o.•c = o. m a n S <br /> Z : ,z i <br /> o -I <br /> � N7 NO. <br /> : y <br /> 11 o.2 = : m <br /> » ° : O <br /> ..... . ....... . ........................................... .... A : o <br /> Rea k gent /.�� .... . . . ....:.7L!/...!S-'C�. e . .....1. ....W�. I. .....................................Jo : <br /> Remarks ..... ......... . .. .. ��.. . . . .� ... . . � 1 .. <br /> .............................5 1 ��t. ....`5(ro ...�.....1.5....rQ. ;;�1. ,.................................................... ..... � : o <br /> ..................................................................................................... .... ................. ... .... ............ <br /> o . <br /> o o <br /> . . g ............ ............... ..... ut N - N <br /> InspectionDate ....................................... ..... .. . . . . ...,�fl/............. ..... <br /> tonin Admi ratoryzn`Y� 8 8 8 8 8 <br /> NOTE: A preliminary site inspection must be made and site app oval granted on all structures involving sanitary f ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has bee i issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />