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Burnett County Office of Zoning Administrator Iu o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 0 <br /> v <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a (Q <br /> o <br /> . ....R. . . ......F.... R.��. ./..V......:. ...............s �- ................................................... N <br /> OW R (pI ase printl CONTRACTOR or SURVEYOR or AGENT a m <br /> wry/§ g c /��� .°i. <br /> ...../.. f�.........7./.7 ../)r..L.::ljl. .F..... . . . a <br /> ADDRESS ADDRESS .. <br /> 1.. /..........e........ /V .,........ . .......................................................................................... <br /> ADDRESS ADDRESS <br /> ...........�-.�f..�../..--..55.7...�.l................................ . . ........................................................................................ <br /> PHONE PHONE . <br /> ........................................................................................... E.L"L...DR...I..LLER........................................................................... <br /> PLUMBER WE. L <br /> ..... . . . ............................................................................... . . ...... . ............................................................................... � '� <br /> ADDRESS ADDRESS <br /> n o <br /> . ...................................................................... . . . . . ..................................................... _. <br /> PHONE PHONE <br /> DESCRIPTION <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details • • 2 E d <br /> New Building ...... ,,, Type o C tr No. Bedrooms <br /> yy�(tlx u��gqQa .......... i <br /> Addition K /YI C"• Septic Tank Size Gals. .......... <br /> Sanitary ..:....... Size .... ..... ft"."x ...... 7r.�. ft. i <br /> Filling/Grading .......... Height............. Stories ......r 4a. Absorption Field Site: <br /> Moving .......... Area :................................... ...... Soil Type .................................... r i <br /> o <br /> Mobile Home .......... Slope .................................I........ .. <br /> Privy , 1 -family Perc. Rate ................................... <br /> .......... 3. Use (describe exactlYc <br /> Well .......... ho e,garage, mot , etc Dry Well .......... <br /> Subdivision /�/(� uA .il Seepage Trench .......... i <br /> .......... ll ` . ....I....... : Priv � <br /> Camping Unit .......... /' Y <br /> .................................................... <br /> Seepage Bed ......... :!^ <br /> --------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road p(}t <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway itT <br /> nter- _a <br /> section, Show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING (((4 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITION p <br /> ------------------------ — <br /> ------------- -------------------------- <br /> 5. Lot Size: nn Fig. A. 6. Location: <br /> ................ ft. x .............. .....r9. .. . A. sq.ft. 4,41..1 ��..h'..Q..ft.17.7......5. '✓..L?�.f <br /> )05 t60^' <br /> o <br /> It POO <br /> ' rtA o <br /> / I C, <br /> r L <br /> Z <br /> 0 <br /> m <br /> t � ` <br /> I1� m r L D as <br /> n Q < c m <br /> "Ci fNTr < C m 'G <br /> w m <br /> Z O o m D o m <br /> o a , <br /> Fn - <br /> a .. � .......... /7 i98f� U p <br /> Signature of Owner or Agent Datu✓ : , o . C <br /> X <br /> Remarks ......................................................................................................................................................................... m m <br /> O <br /> n <br /> ........................................................................................................................................... .. ................... <br /> Inspection Date ....................................... ...1% ... ....... . ........ i C o rix o u o N m <br /> m <br /> Zoning Admini rator o $ o 0 0 o y <br /> NOTE: A preliminary site inspection must be made and site approvul granted on all structures involving sanitary facili ns <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 plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoker) if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />