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C9?'l C�7 yC1 <br /> Burnett County Office of Zoning Administrator �' c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <br /> 1'O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and p �^ <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the n £ <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 3 i1 <br /> regulations of the Stateof Wisconsin. a <br /> ................ ....off/1 'G.. S....... . .....1��}.k ............................ A <br /> OWNER(please print) CONTRACTOR or SURVEYOR or AGENT i <br /> Y•. /...rSD.......ff�ak......i r.;..�. ............... ......../'o.X..... a. .......................................................... d <br /> ADDRESS ADDRESS <br /> Cd. n..R.i..S......%!.e. �1f.5...... �1..5'S/i� <br /> .......... <br /> l. t.. ........1�1.�5: <br /> .....7..^2, ..:/... . ............................................ <br /> ADDRESS ADDRESS .............. <br /> nlp.ql................................... ......... .................................... <br /> PHONEPHONE :V <br /> .. . ...... ............................................................................... . . . ..................................................................................... <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESSn G <br /> PHONE0 k4 <br /> PHONE Z � r• ;� <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° A, <br /> 1. Work: / 2. New Building Details No. Bathrooms .......... c :S <br /> New Building ✓ Type of Construction: _ No. Bedrooms .......... >v, <br /> Addition ,....,..,, Septic Tank Size Gals. .......... ?� <br /> .FAA(VIC.....(Zfflzd4..�....... <br /> Sanitary .......... Size ... ft. x .... ... ft. h i <br /> Filling/Grading .......... Height............. Stories ...../........ 4a. Absorption Field Site: A <br /> SoilType .................................... 'K r <br /> Moving .......... Area ........................................... PLI o <br /> Mobile Home . ...... Slope ...........................I.............. 1t <br /> Privy .......... 3. Use (describe exactly,.1 •family Perc. Rate ................................... <br /> Well .......... home,garage,motel, etc.) Dry Well .......... _ <br /> Subdivision Seepage Trench o ' <br /> 9.bj.I'.`(. .. ................ <br /> Camping Unit �V/ Privy .......... <br /> Seepage Bed .......... <br /> ____ ---------------- _____-----------_—__—_-----_ I N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at —C <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. „<—, <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ------------------------------------------- ------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> k..�...... ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> � l <br /> a 0 <br /> z o <br /> o T <br /> vv <br /> s8f r <br /> " r <br /> Y� O <br /> I v � <br /> n :V N9r/� r D co co: -0 <br /> 0 00 <br /> VT muN,ngac �c � am nny <br /> v m `G m o m 3 <br /> OuyOr 2.vv A o w '� a <br /> I Na : y <br /> �o c m <br /> o 040” o D <br /> m � _ <br /> G✓v ... '................. .. .�/../... .... h o <br /> Signature of Ow or Agent ate <br /> Remarks T <br /> N <br /> ......................................................................................................... ...... ............... . . N : W : <br /> I N m N a N T <br /> Inspection Date "� "� g a <br /> ..... . ......................................... <br /> Zoni Administrator 8 8 8 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />