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Burnett County Office of Zoning Administrator � co o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ,. <br /> d <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N o ,l.ti <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e � <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> G/944 $ maurin.e Me iin Sec y cp <br /> OW ER (please print) CONTRACTOR or SURVEYOR or AGENT m `„\ <br /> Ca �1-� <br /> ADDRESS ADDRESS -'F' '''' k <br /> C f.7/wr..1..&..,..It'/6C&f.35/C1 53142 �` <br /> ADDRESS ADDRESS <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER . <br /> 0 <br /> ADDRESS ADDRESS h 0 <br /> 'o .4 <br /> PHONE PHONE z H r <br /> DESCRIPTION 4. Sanitary Facilities: 9 o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building Type of Construction: No. Bedrooms CD <br /> Addition Septic Tank Size Gals. <br /> Sanitary Size ft. x ft. <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type o <br /> Grading Slope k <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate <br /> Privy home,garage, motel, etc.) Dry Well �. <br /> Well z., Seepage Trench S3.z <br /> Subdivision Privy t <br /> Seepage Bed 4 to <br /> N - <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road 11 c <br /> cs <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING G < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' 4, <br /> U\ <br /> 5. I e: <br /> ft. x .t.1?.b ft. — Fig. A. 6. Location: <br /> sq.ft. <br /> cn <br /> o <br /> w---- go' --:i N o• <br /> c <br /> well N A �` <br /> t L) Dew& llin9 <br /> a CI <br /> 5o _ o <br /> Pr!vy,P <br /> '4 * <br /> L7 <br /> . ..., <br /> T z Do <br /> CD <br /> Do cnr cncvz <br /> m c c. _. m v c ro <br /> a try <br /> Q Q, Y ✓'4 0' <br /> -6 p i <. C d 3' 0 <br /> Z 0o fD . . CD . <br /> o ,7 <br /> {1 c . <br /> 0 <br /> '14/110k., CM 012,6 : - F -0.- ..N-cc?, <br /> Signature of Owner or Agent Date ,.. <br /> X <br /> Remarks m <br /> CD <br /> CD <br /> CS <br /> Gl�.: e $,tez -1 C <br /> Inspection Date �z,l \° 0 0 0 0 0 01 <br /> ) <br /> Zoning Administrator o o o 0 o o <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />