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Burnett County Office of Zoning Administrator c -o zCllJ <br /> 0 CD 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 0* \. <br /> a) <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '<' H 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c , ,(-2. :SW <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a CD <br /> h Q k... 0 <br /> 1 y <br /> OW ER (please print) �( � � CONTRACTOR or SURVEYOR or AGENT a <br /> J)15av— <br /> ADDR SS ADDRESS °1 <br /> '`,r `n <br /> ADDRESS <br /> � Pt*IV �-� 7� _ <br /> 6 /� 93A-� 9 -/ ` ADDRESS <br /> PHONE /C� PHONE <br /> NI <br /> PLUMBER WELL DRILLER1 . <br /> 1-1.,. <br /> n <br /> ADDRESS ADDRESS <br /> 3 o <br /> PHONE PHONE o • <br /> 3 <br /> DESCRIPTION 4. Sanitary Facilities: .o o <br /> 1. Work: No. Bathrooms -o <br /> 2. New Building Details <br /> • <br /> New Building Type of-Construction: No. Bedrooms ,qe o <br /> Addition L_---"" C. Septic Tank Size Gals. , ,=, N IP <br /> Sanitary Size ft. x ft. <br /> 7c <br /> Filling Height Stories 4a. Absorption Field Site: t , <br /> Moving Area Soil Type <br /> r <br /> Grading Slope o <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate r\'({ <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench k• <br /> Subdivision Privy <br /> Seepage Bed <br /> to <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road - 0 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- i _a` <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING t� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> (,,,N. O T <br /> 5. Lot Size: Fig. A. 6. Location: 1. <br /> ft. x ft. — sq.ft. N, <br /> N it <br /> "I 7 n <br /> -•C• -t <br /> N 5 <br /> o <br /> c <br /> O 415 No. <br /> g416tr 0 <br /> • _ 9r_ _ ail'1 l <br /> �C 74 _ 1 SCK 10 ,`� w <br /> ' <br /> TJ <br /> �— —_y,. <br /> r = <br /> -a <br /> EXISTIu<-- c.. <br /> C /N z t) <br /> 0 <br /> m <br /> 0 <br /> CO <br /> CD <br /> 71 <br /> CD C N -. co C CD <br /> Z bZ , y C < Ln m <br /> o. fDJ .0 `D 70 <br /> 0 <br /> a <br /> m <br /> 4/-2-4/..e5t c) <br /> signature of Owner Age t Dat 44 <br /> X XI <br /> Remarks -n m <br /> CD CD <br /> v <br /> N <br /> 0II <br /> Inspection Date ,4?-ja4 �G-ztil � C000o01m <br /> MI <br /> Zoning Administrator ,cj o0000oC <br /> OTE: A preliminary site inspection must he 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 /> pis application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> 'ith 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 />