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;i <br /> Burnett County Office of Zoning Administri for �' c <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 describedand <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the n <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations he State of Wis sin. ,. <br /> c - v <br /> .Q. ........................ ..................................................................................... ...... n,l <br /> OWNER (please print) ( CONTRACTOR or SURVEYOR or AGENT {� <br /> �� .L�1.... tr�n.uu ..7 .0 .: ........... ..................................................................................... ...... d s <br /> ADORE$$_ f..�.l.�.l•u............J.� (J.................... ADDRESST— <br /> ..... . . . .................................................................... ....... C% <br /> ADDRESS ADDRESS �--t <br /> ........................................................................................... .................................................................................... ....... : C <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER <br /> p \/ <br /> ADDRESS ADDRESS m <br /> » 0 <br /> N, 11. V <br /> ........................................................................................... . ....................................—.................................... ....... Z r <br /> r <br /> PHONE PHON........E = <br /> DESCRIPTION 4. Sanitary Facilities: ° o °» <br /> 1. Work: 2. New Building No. Bathrooms .. """ <br /> Details ' a <br /> New Building .......... Type e of Construction: No. Bedrooms .... g <br /> Addition .................................................... Septic Tank Size Gals. .... <br /> Sanitary I//�� Size .............. ft. x .............. ft. .. ....... i <br /> Filling/Grading r,f w Height............. Stories ............... 4a. Absorption Field Site: i E <br /> g V' ................... . . . ... Soil Type ............................ ....... <br /> Movin .......... Area ............ . . . . .. r <br /> MobltoHome Slope .................................. ....... o <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................... ....... <br /> Well .......... h e,gar ge,motel, a c.) Dry Well .... <br /> Y4 5. Seepage Trench z <br /> Subdivision .. . . 1r.{tkJ.f.r. ........ .. ....... o <br /> .......... <br /> Camping Unit Privy .. ....... <br /> .......... .. . ...................V......... . <br /> Seepage Bed .. ....... <br /> ------------------------------------------------------------------- — <br /> — I rn <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. I— c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at ^l <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. y� <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. _ 0 <br /> _ <br /> ___________________________________ ______________________________ _ . <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ...................................................................... ........ ) <br /> o' <br /> o = <br /> _ <br /> r� <br /> PC Z <br /> mo <br /> o <br /> c.� n fno < On = o m <br /> nm nny <br /> ON . � ppO <br /> Z 6 r D : 1 <br /> o <br /> c = m <br /> ...f..O....w.. .... ...A... .............................. ...................................... <br /> x n ; m <br /> Signature..oner.. or.. gen.. tt Date <br /> O <br /> Remarks m <br /> 0 <br /> 0 0 <br /> .................................................................................................................................... ............................................. ..... <br /> o : <br /> Inspection Date ro ro N m <br /> ........................................................................... . u p u oou M <br /> Zoning Administrator o <br /> � 88888tn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f ilities before construction <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 beeri 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 />