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Burnett County Office of Zoning Administrator Cl) -0o 0 <br /> APPLICATION�FOR SANITARY — LAND USE — BUILDING PERMIT h' 3 N <br /> a, r' o <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 co c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. o �� <br /> l'INT /D,ti -54144 ll5• H m � OC <br /> N rF < <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT C- <br /> 4e"A / &)X i 99' � ., <br /> ADDRESS ADDRESS <br /> ADDRESS ADDRESS <br /> il) <br /> PHON PHONE ,� <br /> ' huin/ l-�t44 <br /> PLUM E WELL DRILLER XI •Nt* <br /> ADDRES ADDRESS <br /> S <br /> ' <br /> PHONE PHONE z H r <br /> DESCRIPTION 4. Sanitary Facilities: 0 o ° Y <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. -15(J.0 4. 4, <br /> Sanitary ,�.,. Size ft. x ft. PufiP A MG5ex3,. ' <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type �?'l.C.4.5..�4..... 0... <br /> N r <br /> Grading Slope `C. * V` o <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate <br /> Privy home,garage, motel, etc.) Dry Well c� <br /> Well / ? Zip / Seepage Trench �..... O <br /> F ' <br /> Subdivision Privy /2 X�S <br /> Seepage Bed yea Q .* <br /> vg <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road D <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q <br /> i <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. ' N <br /> 5. Lot Size: �'2 ,4t!, � c. Fig. A. 6. Location: o' <br /> v- <br /> ft. x ft. — sq.ft. 1 <br /> SFt 417T'ell E4 P1761i/.$ o <br /> co <br /> 0 <br /> 0 <br /> 13 <br /> 5 <br /> a. <br /> m <br /> m <br /> Z <br /> 0 <br /> m <br /> 1 `CD <br /> fD <br /> 1 <br /> ‘., <br /> 70 Cr)r CO Z <br /> am)C C- 7 _ <br /> fD C CD <br /> CD, N Ca:0_< c <br /> -6 o' s' 0 -a <br /> b Z. <br /> . : 70 <br /> - * m <br /> Z oo fD m <br /> 0 ._ 0. g <br /> cr, co - <br /> &//trk.::/ /1'2tt3->"t__/ <br /> ./- o <br /> 6\o XI <br /> /0,2j r3 c p <br /> Signature of Owner r gor gent Da ° C <br /> Remark C<<`1�-�/t— CD Do <br /> i7... .. _ <br /> y II <br /> Inspection Date3 944,140 ° o 0 0 0 o ci, m <br /> Zoning Ad inistratorl�� o 0 0 0 0 o cmi) <br /> DOTE: 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 />