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Burnett County Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and ' <br /> r <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the T <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and3 `8 r :0 <br /> regulations of the to of Wisconsin. 3 a <br /> mr),-t��k,S....... ttrJAf r.. ....G a'm........... .�`1LCS'�Sct .. •drtr� .} G`On^ 1 !`j................. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> 3ra%z .. > #.�.7. $.ST.. ......S.�.tft7t�.............5 .(5............. �.7.�—............ d <br /> ADDRESS �f ADDRESS ;O <br /> ,e�c .Cit+ar� ....�5T5A......N1�.J�... 5U7SJ............................................................................................ f <br /> ADDRESS ADDRESS t jY <br /> PHONE................................................................................ .PHONE................................................................................ <br /> .. . ................................. .... l <br /> P Me WEL RILLER `VVI <br /> O t=r— <br /> .......... <br /> .AD... D....RES.................................................................................... <br /> ADDRESS S m C) <br /> O. o <br /> < ; <br /> PHONE PHONE Z ,On r :O <br /> DESCRIPTION 4. Sanitary Facilities: <br /> h <br /> B <br /> No. Bathrooms <br /> 1. Work: 2. New Building Details •••••'•'•' <br /> New Building ,,, ..... Type q�Construction: No. Bedrooms :.. `A� <br /> Addition ,,,,,,.,,,77, r�4,`"�!,¢ Septic Tank Size Gals. <br /> Sanitary .... Size ...... .. .... ft. x ..... 75,.0 <br /> ✓✓ r� <br /> .... aT ..... ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: i :e, <br /> Moving .......... Area ....................................... Soil Type .................................... r <br /> :e - <br /> Mobile Home Slope .......................................... <br /> .......... ; <br /> Privy ...,,,,,,, 3. Use (describe exactl , 1 -fam' Perc. Rate ................................... <br /> Well .......... home,garage, motel,a Dry Well .......... <br /> Subdivision Seepage Trench o <.- <br /> .......... .................................................... <br /> Camping Unit .......... Privy <br /> .................................................... SeepageBed /B.X�y i <br /> . t in <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fig. A. '� c y <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at �IjJ <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. :1 o' •� <br /> ----------------------------------------------- CJ ; <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ........................•c�.Q Cnrf sq.ft. ........ ... . .......................................................... <br /> noS�✓+` � 1 _^ a <br /> 3 <br /> N 0 <br /> c <br /> G O <br /> O � J <br /> 1\\\ 0 �Q <br /> ( I 0 <br /> 6 <br /> _J <br /> O <br /> m yv <br /> Z V <br /> O <br /> 76 <br /> -� <br /> J <br /> —z Sof <br /> mvtnr > <br /> J— C any <br /> V O �J Cn <br /> o 0 o Mn <br /> ; <br /> ...gn.'a,u. . .... ... .......... t.............................. ...............6a"t'................. <br /> x p, i m <br /> Signature f 0 er or Agent Date <br /> � H ' <br /> Remarks m a <br /> O O <br /> Inspection Date ....................................... meQi. u.0 <br /> . . . .. . ..... . d7�1 ....... 25 8 S FCO'9 <br /> Zoning Adminis for ' <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 />