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l <br /> Burnett County Office of Zoning Administrator c - o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> d <br /> ro THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y -h <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use � c <br /> Jrdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n. oS 1 <br /> ,q+ 5) O <br /> JWNER (please print) CONTRACTOR or SURVEYOR or AGENT a 7 <br /> ��FF . ,�CLe./PP/C — / i/S,— S ` Y 32 a 40D SS ADDRESS - <br /> , ts•-• k4 Z <br /> DDRESS ADDRESS ".,‘ <br /> 'HONE ,� PHONE N\ `Ij <br /> .../4./, 2, <br /> zit/pis a N vsi ,-\.3 <br /> 'LUM/BER �/� i. ��(�/ ? WELL DRILLER <br /> DDRESS ADDRESS N 3 0' t .5?-6—& 0 o <br /> o .-+ . <br /> 'HONE PHONE Z y •DESCRIPTION 4. Sanitary Facilities: o o o <br /> 1. Work: 2. New Building Details No. Bathrooms .. ... U o <br /> New Building Type of Construction: No. Bedrooms .. .... c9 <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 /.Yd 93K m <br /> Grading Slope CI 0'-. <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate 4?7Li <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench <br /> Subdivision Privy — • <br /> Seepage Bed <br /> ; > <br /> Cl) <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road — � <br /> a- <br /> 11.1 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- \, o <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. O \rr__ <br /> V? <br /> 7 5. Lot Size: Fig. A. 6. Location: <br /> ft. x ft. — sq. ft. <br /> 4cn <br /> n <br /> o I <br /> 0 <br /> i IN 0 <br /> \\ <br /> 1 "�J <br /> J <br /> A x-, 5 <br /> Cs <br /> cn <br /> co <br /> c * cn co Z <br /> a, n r v c cu . cp CD E CD <br /> -o cn <. c v E• O � <br /> ov, y um * m <br /> 0 0 -. "D m70 <br /> c.n to - <br /> �Q o <br /> o <br /> /—� �3 �� m <br /> NI XI <br /> .0-,d.C7a--*C--1-tseN- <br /> 0 <br /> C <br /> signature of Owner or Agent Date <br /> X 70 <br /> Remarks -n m <br /> cp r CD <br /> 63 _ <br /> L\ II <br /> 4 <br /> nspection Date • <br /> ry�eo , ,�2L� 71 <br /> o 0 0 0 o cNi, m <br /> Zoning Ad nir ZC`J 000000 � <br /> OTE: 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 /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig until a perm it has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith 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 />