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i r <br /> Burnett County Office of Zoning Administrator � - 0 0 <br /> • ' AP?LICATION FOR SANITARY — LAND USE — BUILDING PERMIT 2. ti <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as v, Z; <br /> • <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD c • <br /> Ordinance, Sanitation Code, and with all other appli able County Ordinances and the laws and regulations of the State of Wisconsin. a ip, 0 <br /> IV h i.e._ e,...,.. s nyye H • O <br /> OWNER printl/f // CONTRACTOR or SURVEYOR or AGENT a CD <br /> ff,,�l((�1�� �,Ef l(v I '° h <br /> ADDRESS ,, ADDRESS <br /> CD <br /> ADDRESS ADDRESS Q <br /> PHOtAmerkA: PHONE <br /> Xr- F'0 <br /> PLUMBER WELL DRILLER `-. it �^ <br /> "1 <br /> t <br /> ADDRESS ADDRESS :ot) co Go7 <br /> h <br /> o' i <br /> PHONE PHONEZ H • <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° `i <br /> 1. Work: 2. New Building Details No. Bathrooms U o <br /> New BuildingNo. Bedrooms .3 <br /> x.. Type of Construction: ) <br /> Addition r Q Bevy. -` Septic Tank Size Gals. < <br /> Sanitary C` Size ..6. ... ft. x a Y ft. i'�'S{", —r <br /> Filling/Grading Height Stories 4a. Absorption Field Site: p <br /> Moving Area Soil Type c r <br /> Slope ).� ra ° <br /> Mobile Home o e • h <br /> Privy • <br /> ' 3. Use (describe exact) 1 -famil ,. Perc. Rate 1 3 .3 <br /> Well xhome,garage, motel, etc. Dry Well e o <br /> Subdivision Seepage Trench w M <br /> Camping Unit Privy V, nt <br /> Seepage Bed /2).% �k X09' <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road Cr) <br /> o C <br /> rn <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- W a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ..,, >I <br /> N <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O 3 E <br /> o <br /> 5. Lot Size: Fig. A. 6. Location: r E. <br /> C/� <br /> ft. x ft. — y at C r t-•" sq.ft. <br /> N <br /> CD <br /> 0 <br /> N g- o <br /> 0 3 <br /> 2 b <br /> . ,•N (A) <br /> o c (/� <br /> I <br /> 4 0 <br /> N <br /> 3 <br /> r )t) <br /> 0 <br /> i(1C11/4° /4 m <br /> 111, 0 z. <br /> 0) <br /> CD <br /> cn r v d w <br /> md � c <br /> ERQ a,� a a <br /> N 'T <br /> rr <br /> Z O O _ D 6- <br /> o = n <br /> ' 6R _ <br /> rr.�� CT1 � 'J � <br /> Vi O <br /> ft <br /> .��' 7/6,/S JO0Signatureoffw i• orr Agent <br /> ,moo c <br /> 1:. l/1..._,Z.:4 CC- :'z/ ; `.' . X 7rrl <br /> 0 <br /> Remarks ,i 0 <br /> CD <br /> fie .` .:.. ...,.� G Cir j II m <br /> Inspection Date .1.—///.- , a' � 00000o44m <br /> Zoning Administ✓3tor cn <br /> o 0 0 0 0 0 <br /> o <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 /> :his 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 /> Nith 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 />