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--0"77 c-&-77 Q.../ <br /> 3urnett County Office of Zoning Administrator �' 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3' o <br /> fO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N -" <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 o_ _ <br /> '. a O <br /> d <br /> JWNER (please print) CONTRACTOR or SURVEYOR or AGENT CD a ^x` co <br /> t <br /> HT; <br /> AINii , <br /> DDRESS �� V � _ ( ; ( ;IA) I , ADDRESS <br /> \ <br /> ADDRESS ADDRESS . <br /> DHONE PHONE N4Q <br /> ?LUMBER WELL DRILLER <br /> v <br /> ._ t <br /> ADDRESS ADDRESS CD o <br /> r+• < <br /> o ,-+ <br /> PHONE PHONE Z N r <br /> DESCRIPTION 4. Sanitary Facilities: ° 5 ° <br /> Bathrooms ra 3 <br /> 1. Work: 2. New Building Details No. <br /> New Building 4,--' Type of Construction: No. Bedrooms 0 <br /> Addition Septic Tank Size Gals. .4 -, <br /> Sanitary Size V ft. x 3° ft. <br /> Filling Height Stories 4a. Absorption Field Site: }� <br /> Moving Area Soil Type !t" or <br /> Grading Slope 0 <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate oQ <br /> Privy home aragmotel, etc.) Dry Well I <br /> Well Seepage Trench W <br /> W <br /> Subdivision Privy <br /> Seepage Bed , <br /> I cn <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road n C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING L7,,- <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Q 5 <br /> C V1 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> /.4..C.. ft. x ... .Zgft. — sq.ft. <br /> kt V E' --- 1 -' <br /> o <br /> ---/- <br /> Lk <br /> o <br /> a 0S (y ^� y • <br /> h a <br /> c. <br /> T-- -1 i \44.. 0 <br /> - `\j o C';'., <br /> / cle...„) Do <br /> Du <br /> C <br /> CD <br /> J.-- ____------,''C:1"..2.. -. 15N <br /> pAvis pki Ue r N <br /> . <br /> - <br /> CD. <br /> 0-<CDQ <br /> OHH •Z - <br /> m <br /> Z OO co <br /> P'1%14:CA D-- / IlY)-‘ I.e.—v.4-- tr---I.--"9---,1 \ <br /> o = <br /> b9 <br /> 71 <br /> S0 <br /> N O C 15 <br /> . 73 <br /> m <br /> 0 <br /> Signature of Owner or Agent Date -,X <br /> Remarks 31-9101-2 .. a?.3 CD is p <br /> CD <br /> ,QJ u <br /> tA <br /> ;kkr <br /> \o .� v, N mInspection Datet2o oOOO•cnm Zoning Administrator A' 3 c o o o o V) <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, a 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 /> with 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 />