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Burnett County Office of Zoning Administrator �' 3 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulati of the State of Wisconsin. � a <br /> 1 €z° LvU �c C� r!rs............. s <br /> 0 .... . ..1....N..A......... .............................. ...../ lr.�s ....... ..................:.6�!sl r'.... <br /> OWlassentl CON RACTOR or SURVEYOR or AGENT <br /> T <br /> 1....1�t.l�.G. :......���.................................... ... ..;r s..:..2..2 �.......A/!,........................................ <br /> ADOR�Es A�RESS � ? — <br /> ,f�.S .. ....... ... <br /> �:....... 5�: � �...... .....lti.IrS S:!4... .. 4.16. . ......5..�.b_S'S................ <br /> ADDRESS J ADDRESS E '. <br /> �.IS .........r�......L...... ..................... ..............` .rZ.'...rY ./........................................ <br /> PHONE PHONE i } <br /> .......... <br /> ........................................................................................... .WE..........DRILL.R'*I'L ....ER........................................................... <br /> PLUMBER LL <br /> D <br /> ........................................................................................... . .......................................................................................... 0 C) <br /> ; <br /> ADDRESS ADDRESS o C '• <br /> ................................................... <br /> ........................................................................................... . . ................................ <br /> PHONE PHON......E Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° °» <br /> 1. Work: 2. New Building Details No. Bathrooms 7777...... c ___. <br /> New Building CA2RC,k ._XType of Cpnstruction: No. Bedrooms .......... R <br /> Addition�l. ,j}F_rK ..x.... ...� J' Septic Tank Size Gals. .......... <br /> Sanitary Size ....c7:7.... ft. x ..-36.... ft. """"" <br /> """"" 4a. Absorption Field Site: <br /> Filling/Grading .......... Height-4.5 .. Stories .... ......... <br /> Moving .......... Area ........................................... Soil Type ....................................... <br /> r <br /> Slope ...................................... <br /> Mobile Home .......... <br /> y <br /> Privy .......... 3. Use (describe exactly, 1 •family Perc. Rate ................................... <br /> Well .......... lh arage,mot etc./ Dry Well .......... _ <br /> Seepage Trench o <br /> {,JpLy� .......... <br /> Subdivision .......... .. ...........S`J•F..'F............ . ....... <br /> Privy ........ <br /> Camping Unit .. [� . <br /> .......... .................................................... <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> W <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at . ' <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. : 0 <br /> ______________________________________________________________________ V' <br /> 5. Lot Size: Fig. A. 6. Location: <br /> W <br /> ./vo...... ft. x ..y.'r��?.. ft. . ............................... sq.ft. ......... ......................................................�...7........... Q <br /> -S,E c, ,J-3 . jvcu.j Si, /,a �{n Na, /rAA% [ 1A1 <br /> A( &'ISSi <br /> N O <br /> O = <br /> IJ O <br /> 4017-0Nem i <br /> OeCL <br /> f 9 <br /> Z <br /> (� O <br /> r��vK <br /> �,�,Pos <br /> _ <br /> � «+Q < _ M m <br /> SD N n c m m � n y <br /> L < d C <br /> fit. O D - 1 <br /> O <br /> / O o : In <br /> .. .. 7777.. 77 .................. .. ................ m <br /> S gnatwn <br /> ure Oer or Agent Date o <br /> 0 <br /> T to <br /> Remarks7777 ... ............................................................................. .............................. <br /> p/'U [ J.... ....� ...uU..... �l e.�.�.�5.��.� ................... '": o . <br /> o <br /> o : <br /> N fD -22 Inspection Date ....................................... .... ....7777 .. ................777.7..........oning Ad IstratorNOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before constui <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />