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Burnett County Office of Zoning Administrator d M 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < ,n o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use E c � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> pMAI/ . . .. m <br /> a <br /> L <br /> O <br /> ............. .... `.'G � . .... -i <br /> OWNER (please print) CONTRACTOR rSU VEYOR or AGENT <br /> ADDRESS .3� <br /> ......... ...52...... ................................................. .......... .5 . ... ... ....... ..... ............................. <br /> �.�+q <br /> ADDRESS <br /> ..... . .....A1.rye-�.t tS l...... .....Is . ................... .... ctr1.'f. .........Y.:...........N.1. .../................................ <br /> ADDRESS AD KESS 'w <br /> ............... <4?.-.6 `1.................................................. . . . ......45.x.. ° ........................................................ <br /> PHONE PHONE 00 <br /> / <br /> . <br /> ........................................................................................... . . . ............l. .... .................................................................. <br /> PLUMBER WELL DRILLER <br /> p <br /> . . .................................................................................. .....................✓,................................................................. <br /> ADDRESS ADDRESS <br /> n 0.. J <br /> ........................ :............................................................... ............................................................................................ o �. I <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: P o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building ,c/ Type of Construction: No. Bedrooms ..../..... z <br /> m <br /> Addition .,,,,, ,,,,, Septic Tank Size Gals. .......... �> <br /> .......... <br /> Sanitary ....... Sizet <br /> .......... . x ft. <br /> Fulingi Grading ......I... Height.... �r..,"./.f Stories ....1......... 4a. Absorption Field Site: <br /> Moving .......... Area ....Sga.. ......2.3.......... ...... Soil Type .............................. ..... <br /> Mobile Nome Slope ............................... 0..... ..... ; <br /> PrivPerc. Rate ............................. ..... <br /> Privy ...... 3. Use (describe exactly, 1 �family <br /> Well .......... home,garage, motel, etc.) Dry Well ... ...... i <br /> Subdivision Seepage Trench <br /> .�............ ..... <br /> Camping Unit ,,,,,,,,,, Privy ,.,,, <br /> .................................................... Seepage Bed <br /> --------------------------------------------------------------- p � N <br /> Location of proposed structures and existing structures, well,Sewage systems, roads, etc-, should be sketched in Fig_ A_ Include road >vJ Q <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 /> 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. <br /> o' <br /> -------- — ----------------- --- <br /> — --- -- E <br /> 5. Lot Size: Fig. A. 6. Location: ; <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... rn <br /> N ° <br /> _ t <br /> 14* <br /> l <br /> t <br /> A <br /> Z <br /> v <br /> mr- <br /> be Cr < <br /> D a n <br /> 'kSFkw OZ 06 ¢Q 7 <br /> � o — <br /> o <br /> n <br /> . / �/ <br /> �o <br /> S4�7 <br /> Owner or Agent Date <br /> X3 <br /> Remarks ......................................................................................................................................................................... T n <br /> � C <br /> fl <br /> � n <br /> ............................................................................................. ...... . .................................... <br /> . .................�... ........ ..(./../l. <br /> .......................... <br /> rection Date ....................................... . . . . . ....... Zoning Ad istratgroa .... ..... ... <br /> u uN o cmn <br /> N , <br /> i $ 00 8 8 0 <br /> A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facllitius <br /> construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must he attached to <br /> lication before a permit will be issued. Do riot purchase or install a septic tank, do any plumhinq or start any build <br /> a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> And to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> R SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />