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Burnett County Office of Zoning Administrator c o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d' 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR, The undersigned hereby makes application for a Permit for the work described and located as '- N .� <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 ll <br /> Ordinance, Sanitation Code, <br /> 'and <br /> /with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n <br /> ...... <br /> v O <br /> , .✓............................. .v .... .!A� [c . ......1..`0....J <br /> ... ...... ................ <br /> / C <br /> OWNER (please print) CONTl•RACTOR or SURVEYOR or AGENT °a <br /> S.1. ...o l......lJu..:.............. .7�... ..... ..LRt.....2_...... ..........7G........................................ a <br /> ADDRESS / ADDRESS <br /> Q......P.yczX .5i:..r..e.k.............. ................. ..........I........ , <br /> ADDRESS ADDRESS <br /> ........................................................................................... <br /> ..........nl./As... ...3�'./.. ...L..../.V. .7.................................. <br /> PHONE PHONE <br /> v i <br /> PLUMBER WELL DRILLER <br /> .........� ........................................................................... ............I.. ........................................................................... � <br /> ADDRESS ADDRESS m <br /> o <br /> ........................................................................................... ............................................................................................ o .. <br /> PHONE PHONE ZH r <br /> DESCRIPTION 4, Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ••••••••• o <br /> New Building ..... Typ of Construction:/ No. Bedrooms .......... <br /> Addition .......... CCb�.ar Septic Tank Size Gals. .......... <br /> .cS ...: S{.......................... <br /> Sanitary ,,,,,,,,,, Size ......�.L... ft. x ....ZQ.. ft. <br /> FillinglGrading .......... Height%.u,/./. Stories ...... 4a. Absorption Field Site: <br /> ....... Soil Type .................................... � <br /> Moving .......... Area ....�.9 ..................... . o <br /> Mobile Home .......... Slope .......................................... ^ <br /> Privy ........., 3. Use (describe exactly, 1 -family <br /> Pere. Rate ................................... O <br /> Well .......... home,garage, motel, eta.) Dry Well .......... �� <br /> Subdivision ,.,,,,,,,, � a o Seepage Trench .......... t i <br /> Camping Unit— ...................................... --- Privy — __ .......... <br /> .......... .................................................... <br /> ------ ---------- --------- Seepage Bed--------- `� on <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road t C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter °- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. \� 0' <br /> -------------------------- --------------------- — — — <br /> — --- -- — <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. .......................................................................... <br /> c <br /> o J <br /> Z.{r.7 z� <br /> o Q) <br /> o <br /> / O <br /> J <br /> 2-10 <br /> VCr✓ <br /> m <br /> `JZ Z oo na37 <br /> o J o 3 <br /> lit" o <br /> --- V = p <br /> jat,, <br /> .... ..... ....................... .. ....L6/./2.. .�{ J..7... o C <br /> of Owner or Agent 'Date / <br /> X <br /> Remarks ......................................................................................................................................................................... m� O <br /> m <br /> ...............................................................................................................................................................................I........ XV II <br /> .......................................................................................................... ... .................................. . . . . <br /> m <br /> Inspection Date ....................................... �?.... .. . .. ... ..... ................. : \: o u, o v, o v, m <br /> ............ ......................... <br /> Zoning Admi Istrator WV 8 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 />