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Burnett County Office of Zoning Administrator 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 < H <br /> 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 ma <br /> 'c� ...... -1 .................................. 0 ° <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> 13 .... <br /> A- <br /> ......... .......................................... t ............~ <br /> C <br /> ADDRESS ADDRESS69.'� P'T1 .- 3 , <br /> yy1 <br /> ADDRESS ADDRESS <br /> ........................................................ ... <br /> ........................ ........................................... .................... i :WWW <br /> PHONE PHONE <br /> st?!.?: ........................................................... ..........N...o! . ....................................................... <br /> PLUMBER WELL DRILLER <br /> O <br /> ADDRESS ADDRESS <br /> 2 0 <br /> ........................................................................ .................................... .. <br /> .............. ...................................... <br /> o 1 <br /> PHONE PHONE Z N r <br /> DESCRIPTION 4. Sanitar Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> 0 <br /> New Building .......... Type of Construction: No. Bedrooms .......... L <br /> Addition ..• L✓QC�/�,,, Frl�7� •• Septic Tank Size Gals. .......... <br /> .................. . <br /> Sanitary ..•....•.• Size ....� `.... ft. x ....haft. <br /> Filling ......... Height....t�....... Stories ..... ......... 4a. Absorption Field Site: <br /> Moving AreaSoil Type .................................... r <br /> o <br /> Grading .......... Slope ................... ...................... <br /> Mobile Home ••...•...• 3. Use (describe exactly 1 -famil Perc. Rate ................................... <br /> Privy ••...••.., —F—or—nq garage, motel, etc. Dry Well .......... <br /> Well Seepage Trench .......... <br /> ......... ......... . <br /> . ...... ...... <br /> Subdivision ! Privy .......... <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 <br /> 6 <br /> setback, s;de 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 C <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. - <br /> ------------------------- ------------------------------- o <br /> 5. Lot Size: ^���rr Fig. A. 6. Location: ,�/ ((�� <br /> �1. ..... ft. x ..cz�.20 ft. — ............................... sq.ft. .......................e....0 ....1 <br /> i <br /> 5th pill j6 A-Tt <br /> 0 <br /> _ <br /> 0 <br /> 0 <br /> T <br /> T <br /> iU <br /> Z <br /> O <br /> d <br /> _ <br /> N <br /> Mcnr -V :ECnamp Z <br /> C d d <br /> T. N Q CL a <br /> 'D Ln < N j• � <br /> Oe•H m <br /> Z oom <br /> (J} 3 <br /> O <br /> vv ......................... ... .... .... ,,'��. <br /> Signature <br /> ✓off�Owner or Agent y ,>- Date f C <br /> Remarks✓.1..t? r1: _ttbt�. �.0:......................................., <br /> -L .U� lLu� x C <br /> co <br /> .................................................................................................................................:.........................I........................... <br /> I I <br /> ..................................0........................................................... <br /> Inspection Date �7 � It>zt �r� 0 0 0 0 0 • fm <br /> ....................................... . ....................... 9....:........ .......... ............... 000000 <br /> G Zonin Admin strator o 0 0 0 0 o CO <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, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may he 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 />