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Burnett County Office of Zoning Administrator M M - 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as H <br /> u <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 Wisconsina <br /> . G. <br /> O <br /> yy fir'- /J <br /> .....`.. ..l.LL:.../ '.f...1: f .!.!{ �.. ..1 .f. f./ .... . ! ......... 1f&.......... �1.. .. ' ........ ...... . .. ar <br /> OWNER (please print) / CONTRACTOR or SURVEYOR or AGENT a. <br /> r <br /> �............l. .. . ..... ...... ./! r- r ( /J rtr. x . . . .f... ...�... ... ..... ......... ..... ..... . g � <br /> ......... . <br /> ADDRESS ADDRESS..... 1 �1 <br /> .A4.G!��. .i',5�!: .....:n), ..Oc.r..........`......: .'..:. ... <br /> ADDRESS ADDRESS <br /> .................... <br /> ................................................................ ....I........................ .................. .... ..... .... .... ..... .... <br /> PHONE PHONE <br /> ........................................................................................... .W... ELL DRILLE......'D"l. '_'ER..................................................................... <br /> PLUMBER <br /> ............................................................................................ � I '~ <br /> ........................................................................................... _. <br /> ADDRESS ADDRESS n o itl <br /> ...................................................•....................................... ............................................................................................ Z <br /> PHONE PHONE <br /> r :r1 <br /> DESCRIPTION 4. Sanitary Facilities: o ° :s, <br /> 1. Work: 2. New Building Details �,p� No. Bathrooms .......... o � <br /> New Building .......... Type of Construction; No. Bedrooms .......... `• xl� <br /> ` - : 'i� Septic Tank Size Gals. .......... •y '» i i<�' <br /> Addition .......... .:a:.�..:...-....... .....:.....:..�..:'............ <br /> Sanitary .......... Size \. <br /> ft. x .............. ft. .......... <br /> 4a. Absorption Field Site: •- <br /> FininglGrading .......... Height............. Stories ............... , <br /> Moving .......... Area ..5:{-!'.lci *...:Y..S.�✓...;it :./...r Soil Type ......................... .......... o <br /> Mobile Home .......... <br /> Slope .......................................... Cy' � im <br /> PRriv erc. Rate ................................... 1 <br /> Privy .......... 3. Use (describe exactly, 1 -family Q py.� <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> ! „� 9 .� <br /> Subdivision ,,,,,,,,,, _.lg,,z,� � �� Seepage Trench ........ r <br /> Camping Unit .�1 _. ` -�..... ...... Privy .......... I) i� : \ <br /> """" Seepage Bed tr, <br /> -------------------------------- ------------------------------------ Vm <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Interis, :1 E- <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURFS AND PROPOSED STRUCTURES AND ADDITIONS. 0. >\ <br /> —————————————————————————————————————————————————————————— ———— <br /> 4 <br /> 5. Lot Size: Fig. A. 6. Zcati <br /> ................ ft. x .............. ft. — ................ .............. sq. ft. ..V..l.....w5.1..7...�.. !.�......... ....... 4°„�,... <br /> 4 <br /> IN <br /> o <br /> -F <br /> o <br /> U <br /> i <br /> I � (nr v v+ m z <br /> c d � d c m <br /> \ as N a a s w n F <br /> m <br /> o a <br /> o <br /> .. _ `� � 0 p <br /> tgature <br /> ..................................... n � ........... ' c <br /> of Owner or Agent l! Date — <br /> X <br /> Remarks ......................................................................................................................................................................... m„ 0 <br /> m <br /> rfl <br /> ........................................................................................................................................................................................ — <br /> � I <br /> .......................... ..................... :\o. . . . . . <br /> Inspection Date ....................................... ....... .'� ......l.............. ... N ro o o "' m <br /> U T N <br /> Zonin Ad Intstrator .1 8 0 o 0 8 8 0 <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, it 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 /> - <br /> vith is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />