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r/ <br /> Burnett County Office of Zoning Administrator d T o 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 < — <br /> sh.own herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use p� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a "\ <br /> /..Z. .......G..( ``�G :n ............................................ ..... .S .f.s.r a... 7rY. ................................................. <br /> OWNER (please print) CO TRACTOR or SURVEYOR or AGENT <br /> �. a L <br /> 7��-�....�1u.C... /ti-...�.Lf..NIS................. �H�6w�„la)p: .....SYf;.S.`).................................... a <br /> ..... 7 .. <br /> ADDRESS ADDRE <br /> U.�!c7J Jt•r:r.. .......... tic..........J '�..h�: .......... ...........................................' V ` ................................................. <br /> ADDRESS ADDRESS ;:()j <br /> IW <br /> PHQK <br /> F.................................................. PHONE <br /> @� <br /> PLU BER WELL DRILLER <br /> ............. :` <br /> ........................................................................................... .AD......DREESSSS... "' .......................................................... ..... _. G <br /> ADDRESS <br /> n o <br /> < <br /> PHONE PHONE <br /> DESCRIPTION0 <br /> 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New BuildingDetails No. Bathrooms L <br /> New Building ,,,, T�{'�e f ConstSuctton: No. Bedrooms .......... <br /> Addition „`�/.M� �,7;,/(; C,f,.,.;�.�............. Septic Tank Size Gals. `— <br /> Sanitary .. .... Size .. ."...... ft. x ...... ft. <br /> Filling/Grading .......... Height...g....... Stories ............. 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ...,................................ r i <br /> Mobile Home Slope o <br /> Privy3. Use (describe exactly, 1 -family Dry Well <br /> Pere. Rate ................................... <br /> --" ,.,,.— home,garage, motel, etc.) ""' " <br /> Subdivision Seepage Trench .......... <br /> Camping Unit <br /> .................................................... Privy <br /> ,......... �7 <br /> Seepage Bed <br /> --- <br /> Location of proposed structures and existing structures, well, sewage systems, mads, etc_, should be sketched In Fig. A. Include road <br /> Q <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property Is located at a highway inter <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. _ T p <br /> ----------------------------------- ---------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: Xl ' <br /> (®f?....... ft. x ft — ............................... sq.ft. <br /> ............................................................................... J_:_ J <br /> m <br /> –fin o ._ J a o. <br /> 1 � o <br /> .r o <br /> m <br /> 'J Z <br /> rzr _Aa��,� F �� <br /> G <br /> as <br /> ll 'V• <br /> 2l <br /> JJ VIr -o rim z <br /> N o W <br /> a cn < c <br /> H' m <br /> -- Z O O n <br /> Ak 0 <br /> ��p 1 m <br /> ...... .. ...�.........�. - p <br /> atureof wnent Date1 ° — <br /> Remarks .......:.,.+�G:-'.e.....- 4'. .f�.. 4r .../.j..Z..: ....:.....e.51. ............. //6 :............................................ x 0 <br /> ........ :T/ :..�...� �:3 � ....��yIG...J:7S. �. cfi..�iD......................_. � . <br /> ............................................... - <br /> SII <br /> ........................................................................1. . x. 31�.�.:1 . ........�.� .X. . ................................................ a: <br /> w <br /> Inspection Date ....................................... .. ............:. . . .. .......... U <br /> ... .......................... 0 0 <br /> Zoning dministrator 8 8 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facllltius <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 it misrepresentation of any of the information conveyed here <br /> with is found to exist. Changes in plans or specifications shall not Ife made without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />