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Burnett County Office of Zoning Administrator CD - 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �. . <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CDC <br /> Ordinance, Sanition Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n. �P <br /> Ff t-'V t ' a <br /> O <br /> K 1 c, K "'4. .Q.. Lr,t)m. F EL T y <br /> OWNS (please print) n CONTRACTOR or SURVEYOR or A1fENT co CD <br /> T/3 Ire. ! 0 v 1E, J Po A n3 i rz-- cJt.l. 6,C� Z. 1 7 G'v ' 1/ i /,107)Al K I l[ °- <br /> ADDRESS ADDRESS co <br /> ADDRESS ADDRESS t <br /> iCk <br /> PHONE PHONE o <br /> r— <br /> PLUMBER WELL DRILLER 4.. <br /> O <br /> ADDRESS ADDRESS m 0 <br /> r) o <br /> o' '+ <br /> PHONE PHONEz N r <br /> DESCRIPTION 4. Sanitary Facilities: P o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building Type of Construction: No. Bedrooms m <br /> AdditionA.i.7. ,��.r� f. Septic Tank Size Gals. <br /> Sanitary Size ...Z.6... ft. x ...a.'( ft. <br /> Filling Height...fr Stories / 4a. Absorption Field Site: <br /> Moving Area Soil Type o <br /> Grading Slope ,k. h <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate O •• <br /> Privy home,garage, motel, etc.) Dry Well k.. <br /> Well 4.rl Seepage Trench <br /> Subdivision Privy <br /> Seepage Bed <br /> C sk <br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road ` a fh <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a <br /> Z. <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. * ti <br /> o' <br /> 0 <br /> v? <br /> 5. Lot Size: Fig. A. 6. Location: •N M <br /> // 7 ft. x 20 1 ft. — sq.ft. <br /> Ci") <br /> m <br /> C) <br /> ,i N= <br /> D <br /> 5' <br /> O <br /> H <br /> '7` o <br /> 0 <br /> s <br /> n. -° <br /> �5 <br /> l ,_ – \yJ <br /> 't! - (D 1 <br /> 1 z <br /> I d <br /> lco <br /> co <br /> I Efri , \ <br /> I ` . <br /> Z- <br /> ' DJCnr7 * CnCOZ <br /> II m. Naa < _ rt Q � <br /> "1 -a0-1 < °7 C' O 'O <br /> ri ' bN. � < um m <br /> 0 3 0 c.° : : a <br /> • 5' E <br /> cri Lizi <br /> -'-I <br /> CA b <br /> m <br /> Signature of Owner dr nt Date <br /> ti <br /> RemarksKQ/l.!..a44 � <br /> - 1�/ m 1, m <br /> CD <br /> CD v( D <br /> ft _ <br /> 33 II <br /> ,f� _, _. _ � NmInspection Date y�Lo/= y� <br /> i(I^ 0 0 0 0 of m <br /> Zoning Admi strator K,/ o 0 0 0 o ccn <br /> VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> :)efore 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 /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ivith 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 />