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..<1--7--)G. e,/7-?%.-• <br /> Burnett County Office of Zoning Administrator 0) 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT .. -. <br /> TO THE ZONING ADMINISTRATOR The undersigned hereby makes application for a Permit for the work described and located as C)N K <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use cc c p <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. -' o o,l <br /> Ili 0 eni F R itA/217 7 RT COv,V Co nvs 7- _ Q, <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a O a) <br /> FL. --ii k _, <br /> • <br /> ADDRESS ADDRESS ' <br /> ou,t D I JN1 Al 5-5- 6''I - o <br /> ADDRESS ADDRESS \ v 11 <br /> PHONE PHONE _ `�' <br /> ell <br /> PLUMBER WELL DRILLER --- <br /> 1, :e . 5 o <br /> ADDRESS ADDRESS T. o <br /> - p6 o e N <br /> PHON PHONE Z H r ZDESCRIPTION 4. Sanitary Facilities: / oo ° <br /> 1. Work: y 2. New BuildingDetails No. Bathrooms `A. v <br /> New Building )...:: Type of Construction: No. Bedrooms i Ul 0 <br /> Addition `/ Septic Tank Size Gals. 7. s <br /> Sanitary — Size ...-�. .;.. ft. x ...3.�l1... ft 15 <br /> Filling Height ( ' Stories / 4a. Absorption Field Site: :� <br /> Moving Area g.,,i�(.� Soil Type ... .t� ;, m <br /> Slope ./..Q , <br /> Grading M 4<4 ° <br /> Mobile Home 3. Use (describe exactld Perc. Rate `3 '— 3— 3 r <br /> Privy home,garage, motel, etc. Dry Well ,fi <br /> Well ii< Seepage Trench <br /> Subdivision Privy <br /> Seepage Bed A �3. .. ,. <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road a- n 1 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- .. E a• <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING �., y• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. c..- o• <br /> 5. Lot Siz t' Fig. A. 6. Location: <br /> .1.a- ft. x ..3 ft. — q2 7� sq.ft. <br /> L. il <br /> N <br /> CD <br /> 0 <br /> N o• <br /> o -ti <br /> c• <br /> o <br /> 0 <br /> V <br /> r <br /> et <br /> v 3 <br /> -. <br /> CD 'O <br /> z <br /> o . <br /> DO <br /> v <br /> c <br /> CO <br /> CD <br /> ° .N.1 <br /> T <br /> m c rcr _. - (if <br /> c <br /> 6 . < c <br /> a). Na. Q< '- rr a_'o 07 < c id c• 0 <br /> o N N < co <br /> z oo `D a <br /> 0 D <br /> Icn <br /> 9q ? . ' '0 <br /> 0 <br /> Signature of Owner or Date � <br /> `••• o C <br /> ,/ X <br /> Remarks 6" l £... d- ' �� ' � <br /> co <br /> 7,z..Le_„,,z„,r, � � ; / � u C <br /> GL c t <br /> Inspection Date .. 1 1 T7o 0 0 • 0 0 <br /> Zoning Ad nistrator o 0 0 o o Vn <br /> DOTE: 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 /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbmg or start any bulki- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> vith 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 />