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e4577 CcQy�aD <br /> Burnett County Office of Zoning Administri itor r Y c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and M EUS <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> reg/ul tions of the State of Wisconsin. _ 'n <br /> .............I......... . ........5 ............................................................ ...... �jzp� <br /> OWNER (PI yrint) CONTRACTOR or SURVE VOR or AGENT . �q <br /> ......5�....... .. .................................. ............................. ... ........... ........................?X.:� 0 : e <br /> ADDRESSA ............... ...... <br /> » ?� '� <br /> z.........-.��...y.01�................... <br /> ADDRESS ADDRESS..................................................................... ...... K , SU <br /> ........... ...........P....3...O.... <br /> .... . .............. .................... . ......................................................................... ......PHON <br /> PHONE <br /> n..................................... oo <br /> ..................................................................................... ...... <br /> PLUMBER _ WELL DRILLER <br /> Y.. ? .........N1cz <br /> .,..,w/. ...... . ........ .......................................................................... ...... <br /> ADDRESS ADDRESS <br /> m 0 <br /> n O <br /> ..................................................... °. 7C <br /> .................................. . ... .. ................................ ...... <br /> PHONE PHONE Vn <br /> DESCRIPTION 4. SanitaryFacilities: / P o <br /> 1. Work: No. Bathrooms <br /> / 2. New Building Details CJ e <br /> New Building y Type ofn <br /> ° str ction: No. Bedrooms .... <br /> P ... <br /> Addition ,• •• , „o .• . Septic Tank Size Gals. ., . <br /> Sanitary ....✓..... Size .... ft. x .+3.x.... ft. .......0 \7 <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: S i <br /> Moving .................... Soil Type .................. <br /> Area ..................—...................... ..................... <br /> MODiIa Home SIOPB ............................. .. . ...... i r <br /> 0 <br /> Privy3. Use (describe exactly,'1 •family Perc. Rate ............................ ...... <br /> J4aM� .......... home,garage, motel,etc.) Dry Well ...I...... <br /> Subdivision ,,,,,,,,,, Seepage Trench .......... <br /> ...............................0.................... <br /> Camping Unit .......... Privy ... ...... <br /> .................................................... Seepage Bed : — <br /> ---------- 9J <br /> ___------__ __ __------_ __------ — I N a\1 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fli;. A. i I <br /> � : <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at ' <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. H <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 0 <br /> -------------------------------------------------------------------- -- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — sq.ft. <br /> IN <br /> terr,,\\ <br /> O ��1 <br /> l <br /> Z Z <br /> O <br /> d <br /> ke <br /> eoO--3�po' s WvMrD00 <br /> C61 <br /> Nem WWPI/f� m �a < ' ani <br /> < d C <br /> $ur : •f N Ob m <br /> N O (O a <br /> . a : y <br /> = m <br /> .....1 yLc `�..1 ;2-�'.'i7..ic1'�tCll <br /> Signature of Ower ori ent Date <br /> �V/�, <br /> Remarks .l./.l�Cl....�.7r.lf...".�`... 't <br /> m �• <br /> w. w <br /> U <br /> W $ <br /> U.I. <br /> Inspection Date .. ..... .... .... ... ..... . ��.'�.—..... ... <br /> Zo ing Adminis ator $ $ $ <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fac lities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />