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was F 4b <br /> Burnett CoOnty Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 3 <br /> o <br /> TO THE-ONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as Z <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use C <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a G\ <br /> f O <br /> d.......�J.....Y.-� .......................................... ................................................. ......................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT ii N <br /> .:......... ....` ..o.X... 8............. ......................... <br /> . ............................................................................................ d v <br /> ADORES ADDRESS <br /> 3 .......................................................................................... <br /> ADDRESS .......................................... ADDRESS r <br /> ............................... ........................................................... ............................................................................................ <br /> PHONE PHONE <br /> t/ <br /> .....N.Qr.'pQi .......................................... . ... . . . .. . ......................................................................... <br /> PLUMBER WELL DRILLER <br /> W. ......... .......lit)...S................................. o <br /> ........................................................................................ , o <br /> ADDRES ADDRESS ;"Q m O <br /> 6- fag <br /> ......................................................................... ............................................................................................ <br /> PHONE PHONE Z �, r <br /> DESCRIPTION 4. Sanitary Facilities: I ° o ° <br /> 1. Work: No. Bathrooms .... ..... :tel <br /> 2. New Building Details o <br /> New BuildingType of Construction: No. Bedrooms .. ... <br /> Addition „ ,,,, ,•• .................................................... Septic Tank Size Gals. <br /> E <br /> Sanitary .:... ... Size .............. ft. x .............. ft. .......... :V <br /> FillinglGrading ...,,,,•„ Height............. Stories ............... 4a. Absorption Field Site: i• <br /> Moving .......... Area ...................... Soil Type .............. <br /> .............. !•`++.” '�• m <br /> t <br /> Mobile Home Slope ... .�.�4....LI .rr...C..,............ 3 `•r i2 0 <br /> .......... �- Y....T. <br /> Privy <br /> .......... 3. Use (describe exact) 1 -fami Parc. Rate ...... .....41 ............ i <br /> F <br /> Well .......... home,garage, motel, etc. Dry Well .......... <br /> Subdivision ......•••. Seepage Trench .......... A <br /> Camping Unit .......... .................................................... Privy .. ..... M <br /> Seepage Bed .,X...... <br /> ______________________________________________________________________ <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road u 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- Wa <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 0 :0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o <br /> ---------------------------------------------------------------------- i <br /> 5. Lot Size: Fig. A. 6. Location: F <br /> ...�.7J. ft. x .............. ft. - ............................... sq.ft. ............................................................................... o o i <br /> o <br /> M <br /> (N ». <br /> o <br /> o !O <br /> o <br /> a <br /> R . FA <br /> P— " <br /> _ { Z <br /> :} <br /> t� <br /> to <br /> n 61 < `° f <br /> -o' <br /> on 2 C <br /> . m < m : m <br /> Z ioo un77 <br /> o Min 3 <br /> s <br /> j C) 1 <br /> i1D m <br /> ...gna14.-t7v-, <br /> .............................. ........................... .......... � o C <br /> Signat re of Owner or Agent Date <br /> X 70 <br /> Remarks ......................................................................................................................................................................... m m <br /> ecs <br /> ....................................................................................................... ........... ................. : : : : : : <br /> oa? N T <br /> . <br /> Inspection Date ....................................... .1.l..?,. ..<C.. ..�e�G...�..,..s.!......................... E i U o o r�,r m <br /> Zoning Admm Istrator KJ g g g g g gin <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving Sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, acopy 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 revoked 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 />