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U • 0-7-1 c—rr-,-, <br /> • <br /> Burnett County Office of Zoning Administrator Cf)v - o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ' g <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as •<' H -h .3J <br /> v.shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co c NQ <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> h! 1 <br /> 1/JC C7iii c <br /> OWNER ease print) _ CONTRACTOR or SURVEYOR or AGENT a <br /> Rt. I Hox ` 1 '— <br /> ADDRESS ADDRESS m <br /> ADDRESS ADDRESS ` <br /> PHONE , PHONE Ni <br /> PLUMBER WELL DRILLER <br /> ,e•-cer--ev—p-Y1-t-ae, NC1 2 i <br /> ADDRESS ADDRESS <br /> 0 <0 �-- <br /> o r. <br /> PHONE PHONE z u' •• <br /> DESCRIPTION 4. Sanitary Facilities: •o o o <br /> 1. Work: 2. New Building Details No. Bathrooms c�.k?‘ o <br /> New Building ...x... Type of Construction: No. Bedrooms !s 9,3 8 <br /> Addition Septic Tank Size Gals. i O + <br /> Sanitary '.... Size A4x :2Ft. x ft. ` < <br /> Filling Height atories ... <br /> 4a. Absorption Field Site: ±� <br /> Moving Area I.'.,2.,, Soil Type r� �^ r <br /> Slope JU <br /> Grading p <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate I <br /> Privy home ara , motel, etc.) Dry Well <br /> Well •,,,, ••• Seepage Trench So <br /> Subdivision Privy <br /> Seepage Bed ' V <br /> l c t' <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road O <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- asection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING t� < <br /> y'®` <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> O <br /> 0 <br /> 5. Lot i : q ?� Fig. A. 6. Location: <br /> s! a ft. x 67� ft. — ....Q.N. ✓,c% sq.ft. r', f <br /> ;_0 <br /> o <br /> 0 �. <br /> 1 / u3 <br /> N <br /> h <br /> —H <br /> o <br /> X'� �l <br /> G 3 P!! `v -a <br /> T <br /> �(1 Z <br /> `. / R Do <br /> '4 . / . n <br /> co <br /> N. <br /> / ..›. " "" <br /> - -_w__ _ <br /> v co cp = *c: 7 C <br /> CQQD -, 'N • <br /> •6 U1 < jW <br /> ZOp Q, <br /> y4 ] •O64 <br /> O <br /> 17i ,, te S .614„L' .04......., Nt,"2 m <br /> 0-/7/971 IS' 0 <br /> Signature ofOwner or gent Date ° — <br /> Remarks ..LP ` /& Ge-r/-- -6'�' ' T x •fir, m <br /> / <br /> . •o • v <br /> O <br /> NO ii <br /> yi„..,24.....) �� C _ NT <br /> (tea` /j �1L ,Q , o 0 0 o cn m <br /> Inspection Date f 10 <br /> Zoning Administrator- coo 0 0 %i <br /> IOTE: 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 /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumping or start any build- <br /> lg until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> fith 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. <br />