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Burnett County / Office of Zoning Administrator ta) co- o
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT -,3_,. D N.
<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as ' y :\.
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use cca c
<br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 aa :-'-`•
<br /> it-Ze4--,er Tieu 4 ,0,e7-31/4-/9,440 17i,�i 4,p.-,e,..5 -/A c= y
<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m a m
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<br /> ADDR SS ADJQQESS I m
<br /> ADDRESS ADDRESS :-N.
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<br /> 6/2-� � �$e - 70 ' f0/., . 5/V -37c'0 ",,IX) ,
<br /> PHONE PHONE ,
<br /> PLUMBER WELL DRILLER Ij
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<br /> ADDRESS ADDRESS
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<br /> PHONE PHONE z 0 '
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<br /> DESCRIPTION 0 l
<br /> 4. Sanitary Facilities: ° o ° c
<br /> 1. Work: � 2. New Building Details No. Bathrooms
<br /> New Building .V Type of Construction: No. Bedrooms C
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<br /> Addition (, )C',P F ►rl Septic Tank Size Gals.
<br /> Sanitary Size ... .... ft. x ..A 1 ft.
<br /> Filling Height et Stories / 4a. Absorption Field Site: {,
<br /> Moving Area ,5.71 __seaF i Soil Type �� 1—
<br /> Grading Slope Si.- °
<br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ��.
<br /> Privy home,garage, motel, etc.) Dry Well 4\
<br /> Well i57•t< Seepage Trench
<br /> Subdivision Privy811
<br /> Seepage Bed s.. Q,
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<br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road ' (\ s
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- �- ?t' o-
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING E- hi
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. rJ Z •N l '
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<br /> 5. Lot Size: Fig. A. 6. Location: , ••••, • iN, k.
<br /> ...l.i Q.. ... ft. x ... 26 ft. — 2 sq.ft. !✓.4 5/Z- Z4.e fl ,. N
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<br /> signature of Owner o U.r Date ° 44
<br /> 3emarks /.U.'...,.5a- taey -'t On a „ x 3../co m
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<br /> nspection Date 9a,„ / 7% .2vrz) 0 0 0 0 o Kn VA 0
<br /> Zoning Admirfistrator IJ , o00
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<br /> OTE: 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 he attached to
<br /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build-
<br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here-
<br /> ith 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.
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