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Burnett County Office of Zoning Administrator /N y 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d - o w <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and Iota ed as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use m <br /> Ordi ante, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisc nsin. 3 a <br /> a> .... nt5 .... ......lnP .................. <br /> .. ......_ <br /> OWNER (please print)�{/-/-�/ CON RACTOR�or S(U'RV�E�Y�O(R AGUE N1TQ/] o. <br /> ... :..11A�.L.....1...)..�E..1.�r1...... . ................................... .kja .....1!W::. <br /> .ADRESS <br /> ....�.1./.Y..'.f .......... ...... <br /> ADDRESS lY� <br /> .............. . ................................................................................ ......... <br /> ADDRESS <br /> ADDRESS IkNf✓.QO. .....!..1.!.".............l..J�.Q..L................. ........... <br /> .. .. ....................................................................... ......... <br /> PHONE PHONE <br /> ........... ... .. ............................................................... .................................................................................. ......... <br /> .... ....... <br /> PLUMBER WELL DRILLER <br /> O <br /> .......................................................................... ........ G1 <br /> . <br /> ADDRESS AD.....DRESS. » 0 <br /> ........................................................................................... . ................................................................................ ......... T' <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> v <br /> 1. Work: 2. New Building Details No. Bathrooms ........• o a <br /> New Building .......... Type of Construction: No. Bedrooms .......... <br /> Addition Septic Tank Size Gals. .......... E ' <br /> .......... ....... ............................................ <br /> SanitarySize ft. x ft. """"" <br /> .......... ( � <br /> Filling)Grading .......... Height............. Stories ............... <br /> 4a. Absorption Field Site: . <br /> Moving .......... Area Soil Type ......................... .......... � <br /> ........................... ............. Lm, <br /> Mobile Home .......... .(T- <br /> Slope ............................... .......... 1 <br /> Pere. Rate ........................ .......... <br /> Privy 3. Use (describe exactly, 1 -family Dry Well (� <br /> Well home,garage, motel, etc.) ........" <br /> . ..... . i <br /> Subdivision .................................................... Seepage Trench .......... :(,7 <br /> --Camping Unit Privy <br /> .......... .................................................... Seepage Bed <br /> Location of proposed structures and existing structures well sewage systems. roads etc-, should be sketched in Fig A- Inclu e road <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at e highw Y inter- <br /> H <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX STING t o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. -v o <br /> 3 <br /> -------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ .......... <br /> ft. x .............. ft. — ............................... sq.ft. :L^ ! E <br /> .................................................................. . ) <br /> I 0. i U) ? <br /> 3 :P LZ <br /> Is o <br /> O <br /> s <br /> 0 <br /> p <br /> � N r � � N m Z <br /> rp C N ]. m j c N <br /> N. N�: c d a _ <br /> 0 > r <br /> 8Z � n n . <br /> fA <br /> 0 <br /> 0 <br /> kXivo (� I <br /> ........................................................................... ...................................... T A <br /> Signature of Owner or Agent Date X 2 ' <br /> Remarks .............................................................................................................................................................. .......... � I <br /> � ° 6 <br /> ........................................................................._..........._.................................................................................. ....... u <br /> ............................................................................................................... ....................... .......................... .. ....... : s» <br /> Inspection Date ....................................... <br /> 0 0 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all strLICtures involving sail(itary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or Install a septic tank, do any fdLionbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the nformation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval o the Zoning Adm lnistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />