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_..---r-s'i c...-v A ✓cam/- <br /> Burnett County Office of Zoning Administrator Cl) H 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ct, B. <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 m c kA) <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. . Q <br /> -a- <br /> . ;O <br /> 0 <br /> 1/7 4/eoi i Gtm/0 /e o8 :/.er A i 4c y cl <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT CD CD <br /> SZ.0 ( t <br /> ADDRESS . ADDRESS C <br /> ADDRESS ADDRESS <br /> yp - Npi14( <br /> DHONE PHONE I <br /> 'LUMBER WELL DRILLER <br /> ADDRESS ADDRESS m G) <br /> ?/6.-43.5'- .> IAI o <br /> DHONE PHONE <br /> DESCRIPTION z ti 0 <br /> 4. Sanitary Facilities: / `° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms "\ <br /> New Building �— TypeNo. Bedrooms <br /> of Construction: �, <br /> Addition k—If/9/+'1L— Septic Tank Size Gals. .8 '0 SU v <br /> Sanitary V Size ..,:l: ft. x 4/0 ft. <br /> Filling Height A Stories / 4a. Absorption Field Site: <br /> Moving Area , 6'4, Soil Type s ' " 7 (Jt o <br /> Grading Slope 6..Y.o... % rt <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate 'aP <br /> Privyhome, Dry Well <br /> gage, motel, etc.) �A <br /> Well Seepage Trench \ <br /> Subdivision Privy "Q <br /> Seepage Bed <br /> 1,' - ( c <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road sk Q)) <br /> t4 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 0. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING c .- r- <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. a o'a <br /> 5. Lot Size: �r6 Fig. A. 6. Location: U <br /> lot?lot? ft. x .5 <br /> 60 0 ft. — sq.ft. <br /> e <br /> (<0; <br /> r; sl5.1. ✓ <br /> N O <br /> o <br /> 0 <br /> 5' <br /> N <br /> 0 N <br /> y <br /> --I <br /> 0 <br /> See 4L7 /1 C=/ 4---0 /4)44/`/ <br /> ,SA a <br /> z <br /> 0 <br /> 7) <br /> v <br /> 0 <br /> aD <br /> L <br /> D cm �� �o <br /> cl, _ - - <br /> m NQO--G .+ O- <br /> Z O O c'D . <br /> o .z <br /> q O <br /> 13 <br /> iignature of Qwnnerr or <br /> Agent Date 1�+ — <br /> ,(.f...f�• x �Q m <br /> xl <br /> 3emarks 9i////p/ m ,p 0 <br /> 70Z140,,,, „....,s7 eeitLt: .4") ri <br /> nspection Date 96,,,,,,,„ 7 � t0 0 0 0 0 cn m <br /> ZoningAdmin' trator Ki o o o 0 o cow <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. <br />