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Burnett County Office of Zoning Administrator Z <br /> o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '< �7 0, :Ya <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 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0. <br /> ...........).1..`<:F:....... ......•- © ................ CO�� CT o S [�U��S O <br /> OWNERIPIease Pri ) \ ...... ..... . .................. .... . ............................................................ H <br /> SURVEYOR or AGENT <br /> 7`�........ssN �/. W571d.3d <br /> ADDRESS fn................................ I .-CY.!.:..w1.. ..... . . L.....i!.4.1J. �r a <br /> ADDRESS { <br /> m <br /> . . .................................................................................. <br /> ADDRESS . .......................................................................................... <br /> ADDRESS <br /> ........................................................................................... <br /> PHONE . .......................................................................................... <br /> PHONE �.p <br /> ......................... ..... .... <br /> .. . ...................................................... <br /> PLUMBER . .......................................................................................... <br /> WELL DRILLER <br /> ........................................................................... <br /> ADDRESS ................ ................... ......................................................................... <br /> O <br /> ADDRESS —' <br /> ........................................................................................... O <br /> m L1 <br /> PHONE . .......................................................................................... :O p' <br /> PHONE <br /> DESCRIPTION Z '^ o <br /> 4. Sanitary Facilities: o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... ; M <br /> New Building <br /> Type of Constr tion: - No. Bedrooms ..........Additiory <br /> )S . <br /> n """""4"P "'�/• <br /> ........ . Septic Tank Size Gals. ..... .... <br /> Sanitary A <br /> .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: <br /> Moving <br /> .......... Area .................................I......... Soil Type .................................... 4- <br /> 17 <br /> Mobile Home Slope .............................. . .. o.......... ... . .... <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate ................................... r: i <br /> Well <br /> .......... ... °" <br /> home,garage, motel, etc.) Dry Well ...... t <br /> Subdivision Seepage Trench i <br /> Camping Unit Privy ,......... ,w <br /> .......... <br /> -- . .......... Seepage Bed .......... v <br /> ------------------- �i <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should he sketched in Fig A. Include road t •� '� <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway Inter t a i <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLYto LABEL EXISTING � 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> Ilk O. <br /> 5. Lot Size: kA <br /> 4 <br /> Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. <br /> Z� Co <br /> G` <br /> N E' <br /> o � <br /> O iU v <br /> F <br /> 1 s <br /> T� m <br /> Z <br /> m <br /> 7 on r v y m <br /> 69 a o < —' c F <br /> N <br /> < N - m <br /> F A <br /> Z O p n <br /> o 6a <br /> on <br />.r..'•'...t .ISN'- .�G....:: .. .... — <br /> ^ = p <br /> Signature of Owner or Agent Date C <br /> Remarks X <br /> ........................................................................................................................................ m <br />.......................................................................................................... <br /> v <br />..........................................................I...... <br /> Eft u <br /> ........................................ .......................................... .......................... kh i <br /> Inspection Date ....................................... <br /> ouo <br /> Zoning Administrator �✓ $ $ 8 $ $ 8 y <br /> TOTE: A preliminary Site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be. attached to <br /> lis application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or rany n build <br /> Y <br /> tg until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here <br /> - <br />�ith is found to exist. Changes in plans or specifications shall not be marle without approval of the Zoning Adm inistratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />