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Burnett County Office of Zoning Administrator 0 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ; 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as m -" <br /> h <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C C J <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> \�J�� N oai :$1 O <br /> .................A.: ........ ..n..................... ............................. ...1.. ...................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> Al ..... ............................... . ....I....... .� <br /> .................... <br /> ADDRESS ADDRESS as <br /> :F [.3 i0f� <br /> sem,st..p©........ m....... :I........ ................ V <br /> _............................................................. j :amu <br /> ADDRESS ADDRESS 4 <br /> l+v� ..-.�1.SS.-Z . ............................. <br /> . .......................................................................................... <br /> PHO E _ PHONE <br /> 7 i 1 i <br /> ..... ... ... ........: ...7..................................... .WELL. . .....DRI.....LLER........................................................................... � � <br /> L MBER <br /> ........................................................................................... .ADD"'"... . .............................................................................. ;'Y1 <br /> ADDRESS DR..ES..S ;L t C) <br /> n o <br /> ........................................................................................... ............................................................................................ Z O 1; <br /> PHONE PHONE <br /> DESCRIPTION r � <br /> 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms '`.0 v 'r <br /> 2. New Building Details ...rr77 : o <br /> New Building ... � Type/94 Construction: No. Bedrooms <br /> Addition ..............!V -! --s:_ Septic Tank Size Gals. ... .f <br /> ... ....................... .. <br /> 7l :O <br /> Sanitary ..✓ Size ..�.... ft. x ....a..�.... ft. ...� <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ...... Soil Type .................................... :�1 <br /> Sloe ° <br /> Grading .......... P . ........................................ C •-. <br /> Mobile Home .......... 3. Use (describe exactly, -famil Pere. Rate ................................... <br /> Privy home,garage, motel, etc.) Dry Well .......... 7 :lam <br /> Well Seepage Trench .......... <br /> .......... .................................................... <br /> Subdivision .......... Privy <br /> ---------------------------.-.......................... Seepage Bed ---- . . ,� <br /> ----------------- age Bed ----------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, eta, should be sketched In Fig, A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highwayInter- <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING (� <br /> '1 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' oC <br /> ————————————— ————————————————————————————————————— — ---------------- <br /> t Size: Fig. A. 6. Location: 1--� <br /> ..�..�.J.�a. ft. x .�.^.1. ft. — ............................... s9. ft. ............................................................................... Ea i r <br /> iS <br /> n <br /> N O. <br /> 6 i <br /> O <br /> A. O <br /> L: m <br /> m <br /> O _ <br /> P2/ a <br /> m <br /> N r N W Z <br /> as <br /> C y d <br /> Z 03 m <br /> : n <br /> E 3 _ <br /> C 0 <br /> O o <br /> Ad ° <br /> p <br /> ............... <br /> Signature of Owner or AgenA Date — <br /> /fj x 70 <br /> Remarksv �� il... —G7Z•.'-y`l..`::.................................................................................................................... ? E E i E 0 <br /> m . <br /> .............................................................................................................................................................. <br /> v <br /> \1 i <br /> . . . . . . <br /> -Ion Date (, y ..�`�� i 0000oaNim <br /> . •:............... . . ...... .. ..................... I° <br /> . .... ..../ . . g . . . ... 000000m <br /> Zonin Adminiy/y� 0 0 0 0 0 0 V7 <br /> '-•eliminary site inspection must be made and site approval granted on all structures Involving sanitary facilities <br /> fiction can begin. In the case of sewerage disposal systems, it copy of the percolation test must be attached to <br /> before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> - <br /> t has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> rist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> " M SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />