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G I�fC 1J0 <br /> . <br /> Burnett County Office of Zoning Administrator d o Z <br /> 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 ll') <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 ma O <br /> 3 a <br /> ........................... ............................................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m _ yE <br /> m <br /> .......... .:eJt. .Y./.!s .... .u.8 `'............................................................................................ a ' <br /> A DflESSADDRESS <br /> .......llJ....!..:S...................................................................... . .......................................................................................... <br /> ADDRESS ADDRESS <br /> C... �5:�.......G.y�.... .s-!� .......................................................................................... <br /> PHONE . ........................................ <br /> PHONE <br /> ........................................................................................... <br /> PLUMBER WELL DRILLER � � <br /> ........................................................................................... <br /> ADDRESS . .......................................................................................... <br /> ADDRESS M o <br /> 0 <br /> . . .................................................................... .PHON..E................................................................................ j <br /> PHONE <br /> DESCRIPTION4. Sanitary Facilities: ° o ° <br /> 1. Work: <br /> 2No. Bathrooms ` v <br /> . New Building Details <br /> o <br /> New BuildingNo. Bedrooms .......... i a <br /> Type of Construction: M <br /> Addition ....... .. .................................................... Septic Tank Size Gals. .......... < i <br /> Sanitary Size ft. x ft. •........• <br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving ......... Soil Type ............................ ..................... ............. .................. ' r <br /> Mobile Home .......... Slope .......................................... „ <br /> Privy ........., 3. Use (describe exactly, i -family Perc. Rate ................................... <br /> Well ../.... home,garage, motel, etc.) Dry Well . ........ <br /> Subdivision <br /> .......... Seepage Trench .......... t <br /> ...............................I.................... <br /> __Camping Unit— .......... Privy .......... <br /> Seepage Bed .......... 7� <br /> _____________________________________ Q 'N <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- kA <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING V K <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> _____________ ____ __--— <br /> 5. Lot Size: 16'_�. �__3 6--'3—------------ : <br /> Fig. 6. Location: o� •�. <br /> ................. ft. x .............. ft. — ............................... sq.ft.t. . . . ................................................................. <br /> W <br /> �ryn5foynet �J <br /> n <br /> N <br /> _X11 dY_ —�uJ ` <br /> 0 <br /> o <br /> 0 <br /> J F <br /> �' s <br /> '° 14 <br /> 0 <br /> a <br /> 11 m <br /> � . y r�vmmZ <br /> m N n m n m <br /> a� rn < •� ro c � <br /> Z 00. : c <br /> o <br /> sD <br /> ' C <br /> Signature of Owner or Agent Date �. J ° i C <br /> X 70 <br /> Remarks ......................................................................................................................................................................... m ni <br /> v <br /> ........................................................................................................................................................................................ � — <br /> II <br /> ..................................................................................................... .. <br /> .. ........... .... <br /> c........... a: . . . . . ........................ <br /> Inspection Date ....................................... . .. .......... ... .... <br /> .... uu. oo tooa <br /> T <br /> ra' <br /> .......... <br /> Zonin At .o.r. ,r; rn <br /> 8 8 0 8 8 8 y <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, (10 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 Adm inlstrat0r. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> tP <br />