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Burnett County Office of Zoning Administrator V no 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 ;� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ' <br /> Ordinance, SanitationnA C//ode, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. _ a tJ•t\ <br /> .. .G....IV.. �..A...l??.�...5 ........................................................................ 3 0 <br /> OWNER (pplease print).. / CONTRACTOR or SURVEYOR or AGENT m m <br /> ...........L.N.Q......!`7.�. /Y. ..�(........Y.eb/...T Alh• S3S// <br /> ........................................ ............................................... m <br /> ADDRESS ADDRESS ' <br /> .. ... ..5..(?. .......... ............... ............................................................................................ >v <br /> ADDRESS ADDRESS <br /> ........................................................................................... ONE 1 <br /> PHONE PH <br /> 8. .........8.a. ..o............................................. ............................................................................................ <br /> PLUMBER WELL DRILLER � <br /> ........................................................................................... . . .. . ............................................................................... <br /> ADDRESS ADD....RESS m C) <br /> n o <br /> r <br /> ........................................................................................... . .PHONE. . .................................................................................... Z N .; <br /> PHONE ' <br /> DESCRIPTIONr <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••••�•• <br /> New BuildingNo. Bedrooms ....? .. i a <br /> .... ..... Type of Construction: „ <br /> Addition ,x,.... „$'„G,/�,e.e.,{./ o, c.�. Septic Tank Size Gals. .......... p <br /> Sanitary .......... Size ..../...0..... ft. x ......;5.l'...Z ft. .......... <br /> Pilling/Grading .......... Height...7.f f Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... 3 : r <br /> ........................................... <br /> e <br /> Mobile Home .......... Slope .......................................... o <br /> f � <br /> Privy Pere. Rate ................................... <br /> .......... 3. Use (describe exactly, i -family M <br /> Well .......... home,garage, motel,etc.) Dry Well .......... : <br /> Subdivision ,,,,,,,,,, Seepage Trench .......... it <br /> .................................................... <br /> Camping Unit .......... Privy .......... oy <br /> .................................................... Seepage Bed <br /> .......... w <br /> — ---------------------------------------------------- N <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- W a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING p <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> C o <br /> ---------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: d <br /> ................ ft. x .............. ft. — sq.ft. o <br /> c <br /> n <br /> 4.100 c 0 o <br /> Sea F1- 6 7 w <br /> 0 <br /> 0 <br /> � CC, F <br /> z <br /> 1 <br /> M :l.V <br /> 1-2Pf z <br /> I <br /> ! O M Nr M wto Z� <br /> a' (Nit <. C . n <br /> o H : m <br /> o o ' n <br /> ......... s/ /a G 1� <br /> .. .. . ... .......... ................ <br /> ............�.. a�ii.............. <br /> Sign lure of Owner or Ag nt Date <br /> X : : : : <br /> : : : : : : <br /> marks ......................................................................................................................................................................... m <br /> ........................................................................................................................................................................................ - <br /> :\ II <br /> ....................................................................................................... ........................ ................................................... <br /> C <br /> �iL,,,, m <br /> InspectionDate ....................................... ... u, o ur o ul m <br /> Zoning Ad inistrator <br /> x I $ 8 $ $ $ $ rn <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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />