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Burnett County Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> ° < <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H— <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 W <br /> �� .... ..... F . ... ................. ............. ....... ....... ............. ...... ......... ............ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> A p /a y <br /> �F....`,�.f/�!.. �1... %..... ............................................................................................ <br /> ADDRESS <br /> �. .... .,....1�J/............................................. . .......................................................................................... <br /> ADDRESS ADDRESS <br /> ........................................................................................... . .......................................................................................... <br /> PHONE PHONE <br /> ........................................................................................... . .......................................................................................... <br /> PLUMBER WELL DRILLER <br /> D <br /> ADDRESS ADDRESS 0 <br /> .............. O <br /> ........................................................................................... . ............................................................................ .: <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> No. Bathrooms <br /> 1. Work: 2. New Building Details """"" o <br /> New Building .......... Type of Construction: No. Bedrooms .......... <br /> Addition Septic Tank Size Gals. .......... <.......... .......................................::..... <br /> Sanitary .......... Size ..�. .... ft. x ...��..... ft. """"" ' <br /> Filling/Grading .......... Height............. Stories ....I......... 4a. Absorption Field Site: E <br /> SoilType .................................... r <br /> Moving .......... Area ........................................... o <br /> Mobile Home . .... Slope .......................................... V, �* <br /> .... . <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ............................. ..... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> e���.��.//////��/��/ Seepage Trench .......... --1 <br /> Subdivision .......... ..S.�.Yy.�.� . .. >1.U.!'.1.... <br /> Camping Unit .......... .. T..�:I✓ .......................... Seepage Bed <br /> -----_--__ 1 (n <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched in Fig. A- Include road cate. <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- j;. <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING �, a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. % .) <br /> -------------- _ _—_— _--__--_-- _------____ i <br /> L.1 R c� <br /> 5. Lot Size: Fi9A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> :- L ' <br /> IN - <br /> o i �J p. <br /> 0 <br /> Io✓s2 8 f1' .. \I o <br /> H <br /> oQ ,• <br /> o <br /> d <br /> 1 <br /> €l <br /> M nry z <br /> (Aa n < <br /> (Nn <' C ' ro <br /> En <br /> z oo a z <br /> E» <br /> .......... .......... :..�...� '... C <br /> Si natOFe of Owner or Agent Date mp_ <br /> X � <br /> � : m <br /> Remarks ......................................................................................................................................................................... „ : p <br /> m . <br /> ei ' <br /> ........................................................................................................................................................................................ . . . . . . <br /> gy <br /> ........................................................................................................ ... .. . . . \ ' : T <br /> . .. ...... ....... ... . ..... ... ............................. <br /> Inspection Date ....................................... ......?7..2.x%. ... -.LL4.��i :` ..J........... " o N Rmi <br /> U r O O T <br /> Zonin Admini rotor 8 8 8 8 8 ti <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, 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 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 />