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• <br /> Burnett County Office of Zoning Administrator <br /> CD CD 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 7.• 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H o \ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use - c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. -, CD <br /> CD <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT co <br /> 1.3 <br /> �i w T tr �Q Q m <br /> ADDRESS ADDRESS /� �T P� 5\y �"3 <br /> r« <br /> p 4 m t CI <br /> ADDRESS .../...�............ <br /> ADDRESS <br /> PHONE PHONE � <br /> r.. <br /> 'LUMBER WELL DRILLER N <br /> ADDRESS ADDRESS o (\ <br /> 0 0 �, <br /> 'HONE PHONE 6 r <br /> DESCRIPTION z r <br /> 4. Sanitary Facilities: •o o 0 <br /> I. Work: 2. New Building Details No. Bathrooms -o <br /> New Building ✓ TypeNo. Bedrooms ° <br /> of Construction: o <br /> Addition I.,QAen r C Septic <br /> Sanitaryf�•!P q�'4 p c Tank Size Gals. <br /> Size .....�.y.... ft. x .-..Y.. ft. .. <br /> Filling Height...J..:'..... Stories ( 4a. Absorption Field Site: <br /> Moving Area 5 >G ;st' Soil Type 1 0 <br /> Grading ` Slope o <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate Q - <br /> Privy home,garage, motel, etc.) Dry Well ^ W <br /> • <br /> Well Seepage Trench <br /> Subdivision Privy 'k <br /> _ Seepage Bed a1 <br /> N <br /> ocation of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road ‘s•V c <br /> rtback, side and back yard dimension and location and setback from all bodies of water. If property is located at a hi hwa o_ <br /> g y inter- t a <br /> ction, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. r;v 0: <br /> ' <br /> g <br /> . Lot Size: Fig. A. 6. Location: N n <br /> C 2 ft. x .. 7.4 ft. — sq.ft. ,: <br /> cn <br /> I 2 <br /> N SPO rt <br /> To t C,. <br /> • <br /> w, 5 w t"V <br /> ,y W <br /> y! ` <br /> S <br /> Pol <br /> D k <br /> /� o <br /> Do <br /> vgnisbe J <br /> , .� 1.- a.'.„.„, <br /> `' S c <br /> �/ -' CD N.) a 0.< - '+• a <br /> . P' - c 0 <br /> C <br /> °�Oo DO <br /> m <br /> ‘244-7 <br /> Inat e wne or Agent Date ° — <br /> x marks co su m <br /> CD tn v <br /> 03 a <br /> E A <br /> JJ II <br /> • <br /> pection Date � �^ o00ocNiim <br /> c2ArYae <br /> Zoning Admin� /co ©coo o ow <br /> TE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> Dre construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> 1 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 />