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• <br /> Burnett County Office of Zoning Administrator d - o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITc. 3 <br /> �. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '- y 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. 3 a ,S.,• :' <br /> O ER (please prirft) or SURVEYOR or AGENT Cu V„ <br /> o i �'0 � wvICONTRACTOR <br /> Cji <br /> ADDRESS ADDRESS _ 1 <br /> 44© � i.ff.. .::�........., l i,.t �..(.191 - - 'ft <br /> ADDRESS ADDRESS <br /> 7;:q.NoN C <br /> 01 <br /> POE CO isPHONE ..,, ,,:,-, .�K <br /> `,r , ...„........ <br /> -5 <br /> PLU BER WELL DRILLER N <br /> ` <br /> ADDRESS ADDRESS 4', 2 o <br /> 1" 1 o < <br /> PHONE PHONE <br /> Z h , <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms / 'AN o <br /> New Building Type of Constructio : No. Bedrooms ....i;',,. 2 ,.^ <br /> Addition Septic Tank Size Gals. O. <br /> Sanitary ..: Size ft. x ft. 1.a. <br /> Filling Height Stories 4a. Absorption Field Site: (/� <br /> Moving Area Soil Type • 0 o <br /> Grading Slope .{• .- <br /> Mobile Home 3. Use (describe exactly famjJaJ Perc. Rate <br /> Privy home,garage, motel, etc.) Dry Well +Z, 7— <br /> Well Seepage Trench <br /> Subdivision Privy I <br /> Seepage Bed 1..t.X. t/ <br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc., should be sketched in Fig. A. Include road -'� !� �a- <br /> cn <br /> E <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- .- ,1 re- <br /> Z. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 9 <br /> o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 p' <br /> I <br /> 5. Lot Size: Fig. A. (N. cr <br /> ft. x ft. — sq.ft. <br /> 0 <br /> N Z,d4 O' <br /> 0 7 <br /> co W <br /> N <br /> r-F %1 <br /> Y C <br /> J. H <br /> S <br /> t -5'T <br /> k O <br /> 5) <br /> Ilk ' 7:::)..1t) V <br /> CD <br /> m C d _. Cl.) CD <br /> _. (pC <br /> `° N.) CL.CL c mom <br /> f3 C.1 < <br /> Z 0 O a, E <br /> o m <br /> Nilii —I— <br /> N. <br /> O 33 <br /> er. -o m <br /> '__ 1 _ o c <br /> Signatu e,of Owner or ent Date n X ' m <br /> Remarks . �/.yi'�.. /. CD 0 0 <br /> , _ _. -" _ L•/i'- !�' i V v SIP <br /> V1 r <br /> Of ii <br /> A <br /> Inspection Date 7 —, i —/ L _ ��L oinobom <br /> Zoning Administrator o o 0 0 o Cl)m <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />