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Burnett County Office of Zoning Administratof R e <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and » yJ <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the xi0 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 � <br /> regulaC sof the Stat of Wisc nsin. C. i <br /> r .. ................................... ............... . .rr...................................................... <br /> OWNER lea-p tl CONTRACTOR or SURVEYOR or AGENT ; <br /> .. <br /> \\// v - <br /> ......... ..PF....../........................................................... ............................................................................................ a :��( i `•+ <br /> ADDR S ADDRESS + <br /> �C{/v�ur� WiS <br /> ....... <br /> ADDRESS ADDRESS <br /> ...................................... ............................................................................................ <br /> PHONE PHONE <br /> .......... <br /> ........................................................................................... . . . . . . ............................................................ <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS m <br /> n O <br /> 0 <br /> i =. <br /> ........................................................................................... . ................................................—................................ N w <br /> PHONE PHON........E Z � r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details .......... e <br /> Now Building Type nstr tion: No. Bedroom .......... <br /> .......... <br /> Addition ...... "'s6, Se tic Ta Size Gals. .......... <br /> . ..... ....t.......... .......... .y.......... . <br /> Sanitary .......... Size ft. x t� ft�3O X .......... i <br /> ............. ............ i <br /> 4a. Adsorption Field Si <br /> Filling/Grading .......... Height............. Stories ............... : <br /> Moving .......... Area ........................................... Soil Type ......... ......................... .r <br /> Mobile Home ,,,,,,,,,, Slope <br /> Privy .......... 3. Use (describe exactly, 1 •family Perc. Rate .................................. � <br /> Well ,,,,,,,,., hogoA,garage mo el,etc.) Dry Wel .......... � <br /> Subdivision .......... ...hop <br /> p•�Lt...t.�. /� Seep Trench .......... o :1 <br /> �S <br /> Camping Unit Pri .......... : <br /> UJ <br /> S page Bed ........ J') <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 backyard dimension and location and setback from all bodies of water. If property is located at `}f <br /> :LJ <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 /> f . . .. ft. x ... ft. — ............................... sq.ft. ..-...... <br /> 1/... .....L. ... .. ............................. <br /> 0 <br /> o <br /> I <br /> d <br /> PL�' cypluve-4 <br /> - 5988 31 � � 0. 00 rn <br /> Wl� UU/ p/t0 / l L O� m NjL ''— nm nam <br /> U N_. <br /> v �< : dCN > > 3 <br /> ZC)o pep iO <br /> O wO D � <br /> o c m <br /> � 0 : 0 <br /> ....................... ....... ........ ............... ... .... <br /> m <br /> Signature O r or Agent Date o <br /> ..... .... 'miRemarks ............................................................................................................................. ........ ...... ......... ...... <br /> u, <br /> m <br /> .......................................................................................................... ... .................... ....... ................................. c <br /> N DD N T <br /> Inspection Date ....................................... .. ........................... u, v. o o m <br /> ...................... m <br /> Zoning Ad strator $ S 8 0 (A <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 />