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ZZ115 FalUD PD -�'-a 7-& <br /> Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> 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 MC <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 M �. <br /> m O <br /> AE..:.. . .........Src.!a.$... r<....................................... ............................................................................................ " <br /> R ( Jase print) (/ CONTRACTOR or SURVEYOR or AGENT <br /> ..k.!k..� se. ..y...........W. I........................................ . . . . . ................................................................................. <br /> ADDRESS ADDRESS 1 <br /> ........................................................................................... .A......... .............................................................................. <br /> Y <br /> ADDRESS DDRES....S �� . <br /> PH .. ......t.................................................. PHONE <br /> PLOMBER WELL DRILLER <br /> .......... o F <br /> ADDRESS ADDRESS : j n o <br /> ........................................................................................... .P..H..ON....E................................................................................... N <br /> PHONE Zr" irs <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms .......... V <br /> 2. New Building Details 0 p <br /> New BuildingT No. Bedrooms i' <br /> ,,,,,,,,,, Type of Construc�on: �������� <br /> Addition ,�c�„j',!,�,y,�,............. Septic Tank Size Gals. . ...._.. j°� ; <br /> Sanitary ,�.(,,,,, Size .............. ft. x .............. ft. I <1�, S-)C!SC9�: <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: IJy„ <br /> SoilType .................................... •m .,--. <br /> Moving .......... Area ........................................... So <br /> MobileHomeSlope .......................................... <br /> .......... <br /> Perc. Rate ................................... : <br /> Privy ,,........ 3. Use (describe exact) -famil ✓ <br /> Well .......... home,garage, motel, etc. Dry Well .......... <br /> Subdivision .......... .................................................... Seepage Trench .......... <br /> Camping Unit Privy .......... �l <br /> Seepage Bed .......... f <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road Zn a <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- _ <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABE E TING N <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ------------------------------------------------------------------ <br /> 5. Lot Size: Fig. A. 6. Location: ' EF <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... : <br /> � <br /> 0 O <br /> � <br /> V) <br /> V1 a <br /> yV <br /> T <br /> A <br /> Z 0 <br /> O <br /> Dot <br /> � 00 N T G y ry <br /> m m <br /> z o o a a z <br /> o a� 3 <br /> vi - <br /> W <br /> iC m <br /> 9 �-,may o <br /> ..... . .... .................. ........................................ ...................................... <br /> Signatur ooff gOwnner Agent Date <br /> Remarks `✓�( �4Z�� ' .. ....................... ................................... m <br /> ................. . .. ...................� ........................... ................ X <br /> � ... ' ..i..... .I . <br /> �:�..?rr.�a . . .Gar-�-r:x..� . . .... .. .................... .... ........................... <br /> Inspection Date-/�.'.C..'�� ! Lt1[EY//��1rG(Q �. t... .... . . o o ren ren 'o u m <br /> ......... .. ......... . .... '.�.. ) o <br /> Zoning Admi ism( trator x U ) ` 8 8 88 8 8 rA <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitiuS <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 be made without approval of the Zoning Administratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> Sim ?V 370 <br />