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Burnett County Office of Zoning Administrator Cl) CD o 0 <br /> • APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT v' 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '- H o \n <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use cc m :� ` <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> f �: a r <br /> G..9'..r.r Q....L.................4 4 w 'et, c '' o <br /> OWNER a.t.(please print) t...1/4) -e,4 3 Ter-v (Ai)., CONTRACTOR or SURVEYOR or AGENT ^ _;( <br /> gi. 4 <br /> ak <br /> ADDRESS ADDRESS 1 <br /> S '. <br /> ADDRESS ADDRESS T <br /> s-.0 , <br /> G <br /> P NE PHONE -...t, <br /> kirk„ <br /> PLUMBS WELL DRILLER <br /> ADDRESS ADDRESS ( o Z <br /> o .4 <br /> PHONE PHONE z y r ' <br /> DESCRIPTION 4. Sanitary Facilities: o g o Q,� <br /> 1. Work: 2. New Building Details No. Bathrooms 1-)1 � '� <br /> New Building Type of Construe n: No. Bedrooms �, 9.3R, Y. <br /> Addition —e____Kr 3 / 0 Septic Tank Size Gals. , <br /> Sanitary .. ... Size ft. x ft. 7ssi"�"�3i�( , <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type o <br /> Grading Slope <br /> Mobile Home 3. Use (describe exact) , 1 -famil Perc. Rate <br /> Privy home,garage, motel, etc.) Dry Well cj e <br /> Well Seepage Trench I , o <br /> Subdivision Privy w -.C- <br /> Seepage Bed 1A.Xcr "C. C^ <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- Q, <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING t y•�,- <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 6—L. p <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x ft. — sq.ft. °' F <br /> CD <br /> n <br /> • r4 <br /> N • o' <br /> o , 0 <br /> m <br /> cm <br /> 0 <br /> '-r <br /> 0 <br /> 0 <br /> n <br /> 7 <br /> 7- <br /> T <br /> z V8 <br /> o <br /> d . <br /> ,?,:,, <br /> `-`P <br /> CD <br /> cn <br /> M <br /> -clk 6 N <br /> .i\ Ll <br /> ii Cl) CO 1 <br /> cp C to <br /> CD NQQ< <br /> r4 oLVI * m <br /> Z CD 5' m . cD 70 <br /> o n E• g <br /> cn <br /> Ut o <br /> Ut o 70 <br /> MI <br /> Signature of Own or Agent Date r. <br /> 1 <br /> t--4 XI- <br /> Remarks <br /> �cV7 77:7'.9/y� • . rn <br /> CD : <br /> Cp. <7.4 --- ' ' d 0-iar . ..._ <br /> II <br /> Inspection Date 1... a77LG4 �CCt 1t4.) \t -en--n <br /> 8 0 0 o N <br /> Zoning Admin stir /c-J coo oott/3 <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 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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />