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., 0 h1 c. i <br /> Burnett County . Office of Zoning Administrator d - o 0 <br /> ' APP'LICATION FOR SANITARY — LAND USE — BUILDING PERMIT B \, <br /> TO THE ONING 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 <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. . <br /> OWNER (pleas print) CONTRACTOR or SURVEYOR or AGENT co CCD <br /> a t <br /> q*e <br /> ADDRESS o ADDRESS C <br /> ,Srt" ��-�,.1 (4ri -s. 5...(.A ON..COMPUTEWSGANNED... <br /> ADDRE//SS ADDRESS -1� <br /> CG.. <br /> PHONEPHONE Q <br /> s -co.,,, \A <br /> LU BER WELL DRILLER <br /> to 6 ? ca Q s-t�w, L� 4 -4 o <br /> ADDRESS ADDRESS '') co C7 V <br /> cl(`-- q ‘C> -- ') 7,.-0 Q IN o• o p <br /> PHONE PHONE <br /> Z H r n <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms l kAt 0 <br /> New Building Type of Construction: No. Bedrooms . 2 0 <br /> Addition Septic Tank Size G@l. .. ..5 it 1 <br /> Sanitary .. .•• Size ft. x ft. <br /> Filling Height Stories 4a. Absorption Field Site <br /> Moving Area Soil Type i&S. L- s o <br /> Grading Slope ....6 ?Q �-+ ra <br /> Mobile Home 3. Use sescribe exact) Perc. Rate .......to I 0 <br /> Privy o - garage, motel, etc. Dry Well r,, <br /> Well Seepage Trench <br /> Subdivision Privy <br /> Seepage Bed x .g.tQ Nr <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road t Lit c 9'1 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- L .-.I - <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 1•A► - <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ► o' <br /> 5. Lot Size: Fig. A. 6. Location: � fl c <br /> n <br /> ft. x ft. — C Vc..c- sq.ft. ' <br /> O <br /> 01 cn <br /> n <br /> a <br /> a. <br /> o <br /> d [ e__et_ ..,-"'• =,' A <br /> ff, c___ :._... <br /> S Z .-. <br /> \ ° <br /> cr D <br /> .10 <br /> cD <br /> jn <br /> CC Y <br /> Do c d -0 C co Z <br /> co, N a_CT Q< <br /> 'O U7 <,c .' C) 17 <br /> _E N m <br /> Z O O co to ii <br /> • 7 6 0• 3 <br /> N. °' CO <br /> d O <br /> O � <br /> �g y— z�-- 8'3 p <br /> m <br /> Signature of Owner or nt Date ° C <br /> XI— <br /> Remarks Cr 4' ( G67 �- • mx m <br /> CD CD <br /> v <br /> vt , <br /> `� 1 g �a c.G, , �r o o o C.71 Q o, m <br /> Inspection Date 4�!'Yr4p ' -�O� ,/ <br /> Zoning Administrator Ooc000cmi) <br /> MOTE: 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 be attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> vith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />