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C)'l r L �' <br /> Burnett County Office of Zoning Administrator 8 0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 D :� <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < H <br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use m ihJ <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and IJthe laws and regulations of the State of Wisconsin. 3tIMeS S �dcP: .11..................... .... . . ... . .. .......... o <br /> .............. ............................................................................ . . �7/ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or..A..GE.NT.. .... . ..... .. ... m <br /> T........�........1✓eb Sf.e.r............................. . .......................................................................................... <br /> ADDRESS <br /> ADDRESS m ^\) <br /> .......... <br /> ....................................................................... . ................................................................................ VJ <br /> ADDRESS ADDRESS <br /> PitoIVE................................................................................ .F F10.... ................................................... .................. E <br /> ................................................ Q^ <br /> l <br /> .......................................................................... v <br /> PLUMBER WELL DRILLER <br /> ....... .. .................................................................................... n 0 <br /> ADDNESS ADDRESS <br /> ............................................................................................ o <br /> PHONE <br /> . ...... <br /> . PHONE H <br /> .. .......... .... <br /> z r <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms .• o <br /> No. Bedrooms • i -O <br /> New Building .,�.... Type of Construction: m <br /> Addition .......... ........................................ ........ .. <br /> Septic Tank Size Gals. .......... <br /> Sanitary .......... <br /> Size ..1..`.�.... ft. x .... f <br /> ...... t. .......... <br /> FillingtGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> MovingArea .............. ..... ...................... Soil Type .................................... ro <br /> Slope .......................................... <br /> Mobile Home .......... <br /> Perc. Rate ................................... <br /> Privy .......... 3. Use (describe exactly, 1 family J; <br /> Well ✓.. home,garage, motel, etc.) r <br /> Seepage ch <br /> Subdivision "•"""' ...� Priv <br /> CampingUnit .......... U Seepage <br /> C-T- <br /> 7 <br /> See a e Bed i <br /> -------------------------------------------------- __---__—_.. <br /> I ed, <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig_ A- Include road Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. I1 property Is located at a highway Inteo- '� a <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ..... ft. x .............. ft. . ............................... sq.it. .................................. r <br /> r be <br /> N o <br /> `a E\ <br /> I � <br /> ai <br /> o <br /> 0 <br /> SLQivr.i� Z <br /> 0 <br /> 311 <br /> I � <br /> 10 <br /> 0 <br /> or,< C ` - dam <br /> yn <br /> L La I Z O O n o 3 <br /> A <br /> Faad e•g � <br /> �7Xf3 p <br /> tr�Y? axe.......................................... .......n}. .... ..... <br /> V ate <br /> Signatu�of O ner or AI�g'�ent _,e,� /l !/D x �. �; ��. � M <br /> Remarks .. .e.(/,fG'�'l! t�...&.. ...'!:..!............................................................................................................ <br /> y m <br /> ........................................................................................................................................................................................ :W <br /> ................................. ... .................... <br /> .................................................................. _ .(^ H T <br /> Inspection Date ! ..��.L..../L 2..... .""""...................... i \�i u o o m <br /> ....................................... j�..lO.. ....... 9 m <br /> f/ Zonin Administrator �� V 0 0 0 0 8 0 Vt <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 lank, do 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 be made without approval of the Zoning Adruinlstrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />