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,?-;7?c <br /> Burnett County Office of Zoning Administrator v o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < m ,C <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 ?� <br /> Ordinance, Sanitation Code,, and with all other applicable County Ordinances no the lawsand regulations of the State of Wisconsin. 3 a <br /> o <br /> � <br /> ............. .o,e'!.... c�h.µso.. ........ p./.S '✓u:.l."'•eco........................................... `^ <br /> a <br /> OWNER (please print) CON TRAC R or SURVEYOR or AGENT m `- <br /> ......... . ............................................................................ .1.4� <br /> ADDRESS ............ <br /> ADDRESS ` ............................................ S <br /> ... ..sa...... /1 knLn............................. I <br /> ADDRESS ADDRESS <br /> ..................................................................... ' <br /> PHONE ...................... . .......................................................................................... <br /> ........................................................................................... PHONE <br /> PLUMBER . . . ..................................................................................... :CA <br /> WELL DRILLER �iy � :r <br /> 1 a <br /> ........................................................................................... A <br /> ADDRESS . ....................................................................................... m u7 S <br /> DDRESS 0 .1 <br /> ct 0 1 <br /> PHONE PHONE <br /> DESCRIPTION <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> 0 <br /> New Building .......... Type of nstruction: No. Bedrooms .......... <br /> Addition ,,,...,,•, . J Septic Tank Size Gals. .......... +N <br /> .............7.... .... <br /> Sanitary .......... Size .......q.... ft. x ....57.... ft. ...... <br /> Filling IGrading .......... Height.......Z.... Stories (............. 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... ;-% r- <br /> o i <br /> Mobile Home .......... Slope .......................................... : .. <br /> Rrivv .�..... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well ........,. <br /> Subdivision .......... Seepage a e Trench .......... 1 i i I <br /> Camping Unit ......•... Privy .......... ' <br /> .................................................... Seepage Bed »�- <br /> — -- .......... <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road 'I Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. I1 property is located at a highway Inter- d <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ) iD <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 'O <br /> _----_.------------------ ---------------------------- <br /> 5. Lot Size: Fig. A. 6. Locatio <br /> ................ ft. x .............. ft. . ............................... sq.ft. .......... a...................... <br /> m <br /> N o' <br /> y � N <br /> N � <br /> h a � <br /> N o <br /> Q <br /> m �C n j N <br /> N N d C < N 4 M <br /> Lin <br /> Z <br /> 08 . D n <br /> 1 j <br /> 9s ,i3 <br /> 9 m <br /> 1. 3 v3 n= f� <br /> c <br /> / .......... ......... o <br /> re of caner or Agent ` � � Date C <br /> Remarks Z,v -, yJ�O� �. i..:Ql"�!!`!-��'..4' ... ...Gl G1/-Cl�iv o?6 G1u leo re x m0 <br /> re <br /> i <br /> ........................................................................................................................................................................................ — <br /> n <br /> ..................................................................................................................... .................. .o. .......................................... � . . . . . . <br /> Inspection Date ....................................... ..(-x???: .N! �... ..�..�... ...................... :`S ren o N o ren m <br /> Zoning Adm nY istrator /C 8 8 8 8 8 8 Cm/s <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, rto any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked it misrepresentation of any of the Information conveyed here- <br /> with 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 />