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e ---ens-","7 C-0Y11.1.f) . <br /> Burnett County Office of Zoning Administrator CD CD o <br /> 0PPLICATION 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 H r <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ccog <br /> ?�,�o <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a 1 :,t. <br /> Flex/ <br /> O <br /> W 4 <1/4A it At y eD <br /> D <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT CD CD <br /> .N..3f(4 Afhl °41-6/2//./fP - a <br /> CD M.k <br /> ADDRESS ADDRESS <br /> CD <br /> /1fa4 fA1 . ( <br /> e , /ilk Cr:P C-. <br /> ADDRESS ADDRESS <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER oq <br /> ' <br /> ADDRESS ADDRESS co o <br /> o< <br /> O' ,-i <br /> �.hs <br /> B <br /> PHONE Bathrooms PHONE z N r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. o <br /> New Building A'� Type of nstruction: No. Bedrooms co <br /> Addition Atfie,. 4'- Septic Tank Size Gals. <br /> Sanitary Size ..../A.., ft. x ;i.. ft. <br /> -$j <br /> Filling Height /2 Stories 4a. Absorption Field Site: <br /> Moving Area ...3J id? ff Soil Type o <br /> Slope p" r« <br /> GradlgHome 3. Use (describe exactly, 1 -family Perc. Rate `� <br /> Mobile <br /> Privy <br /> home,garage, motel,etc.) Dry Well ' <br /> Well ` 6- A At _ Seepage Trench Cr <br /> Suo•'vision Privy W <br /> ''" Seepage BedtAi <br /> -- , cn <br /> Location of P eased structures and isting structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road _ ° <br /> setback, side an back yard dimensio and location and setback from all bodies of water. If property is located at a highway inter- <br /> section, show th,'ntersecting highway nd the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING c <br /> H• <br /> STRUCTURES A r PROPOSED STR TURES AND ADDITIONS. C 7' <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x .... ft. — sq.ft. <br /> .Y‘ ,4e, y \ .skit' of HMry si49d 741"/ X/Z Jtyiu <br /> cn <br /> CD <br /> O O. <br /> \ , 0 <br /> 0 <br /> , b0 <br /> 0 <br /> Cn <br /> //f::; N <br /> z <br /> I 1 ° m <br /> a) <br /> 0t <br /> \si 1 77 Nr 7*,„(/)at Z <br /> ry C a) . cp N C CD <br /> N—. <br /> -a CJ7 Z.C 0.., � 0 '2 <br /> QN N -< c * m <br /> Z O O m m M <br /> •0 fe 0 g <br /> ,?0 7p <br /> di:4pm <br /> 0 <br /> Signature of Owner gent ° <br /> Date <br /> X • <br /> Remarks - <br /> ii t <br /> nn <br /> Inspection Date o 0000.4,01 <br /> Zoning Administrat r lc•J 0 0 0 0 0• 0 <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 />