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1„, Dw" � 'Burnett County Office of Zoning Administrator co 0 0 <br /> AI3PLICATION FOR SANITARY — LAND USE — BUILDING PERMIT •Iv g. ' ' <br /> o <br /> TO THE 240NING 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 m m <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. B a <br /> 4. a S' O <br /> 7 ee frN. d7:e ir <br /> OWNER (p ase rint) CONTRACTOR or SURVEYOR or AGENT (1). � f) <br /> p� <br /> ADDRESS ADDRESS 7 <br /> A <br /> ADDRESS ADDRESS f' <br /> t'LN <br /> P E PHONE ,o <br /> 7 <br /> •PLUMBER WELL DRILLER <br /> '` <br /> 0 C <br /> ADDRESS ADDRESS N iii o <br /> a ` Ao , <br /> PHONE PHONE z H - <br /> DESCRIPTION 4. Sanitary Facilities: / P o o <br /> 1. Work: `, 2. New Building Details No. Bathrooms o <br /> New Building Y Type of Construction: No. Bedrooms ..... .. <br /> Addition Fr Q "h^ '4e. Septic Tank Size Gals. <br /> Cl) <br /> Sanitary ....Y Size ..4l..V ft. x ..3io ft. ?. o <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area 7.a.41/27 it Soil Type o <br /> Grading Slope et '+ <br /> Mobile Home 3. Use (describe exactly,411000E0 Perc. Rate t"( "i 41. a <br /> Privy home,garage, motel, etc. Dry Well S <br /> Well „X,,,, Seepage Trench <br /> Subdivision Privy /.6)CD <br /> Seepage Bed c/ <br /> 14-. c <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 inter- E. Pi <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING �� � Zit <br /> �-. <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 1 p p P g' <br /> 5. Lot Size: Fig. A. 6. Location: SU'(" <br /> ft. x ft. — sq.ft. -tit JG <br /> 1 <br /> o N <br /> ecii <br /> CD <br /> 3. <br /> () 4'0 c9.. .. 0 . ›- --^ . <br /> iliti Zledi /49 5.4.3.., ' . <br /> N <br /> i S <br /> m <br /> 4 <br /> CD <br /> . <br /> d <br /> O <br /> Li2 ‘ 7 <br /> CD <br /> frC, C/ <br /> r6i1 <br /> mm c on 7 c d W - <br /> m. Naas = ,-M • <br /> rt'a <br /> cn <.0 m <br /> N N <br /> 3 � <br /> Q _ <br /> z oo' cc .• <br /> o = <br /> . <br /> Ng 0 <br /> s 7;m <br /> S' ature of caner or Ag nt Date C <br /> � ,/1Z,-,;:iti., x m <br /> emarks m m <br /> CD <br /> _, N mCD <br /> Inspection DateP c2.. '� / I° ... o cn 1m <br /> Zoning Ad inistrator o 0 0 0 o c!) <br /> VOTE: 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 plumbing or start any build- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> nrith 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 />