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/ f <br /> Burnett County Office of Zoning Administrator :v CD 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CDI CD <br /> V1 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 o_ <br /> + Q <br /> �r �.'• ......................... N o/ LAB...... t�r�.� .................. � <br /> u: <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .. ....... ! Tr ....... .......�./......... .....:......?..v.3u. . �. .......:...- ....3................. - �A <br /> a <br /> ADDRESS � <br /> ADDRESS ' <br /> AI - cl Q <br /> . .....`.�c... ...... ......` ........ � �� ............................................................................................ G► <br /> ADDRESS ADDRESS <br /> ........................................................ <br /> .. ... . !.. .... .............. .....................................................PHONE PHONE :\Q <br /> .f4........ ..L..... Z.12r......................................... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> ..o 0.o <br /> ADDRESS ADDRESS <br /> z.4k-(- 3�"Q 9 < <br /> ........................................................................................... ............................................................................................ O r+ <br /> PHONE PHONE z H <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> No. Bathrooms <br /> 1. Work: 2. New Building Details <br /> New Building No. Bedrooms S1L L <br /> Type of Construction: <br /> Addition .......... d�.4'? .••••,,,.,,. •••• . Septic Tank Size Gals. <br /> Sanitary ...N... Size ..:Llv.'.... ft. x ...;3` ... ft. <br /> Field Site:Fi i Absorpton te:e <br /> Filling .......... Height.....�..... Stories ...... ....... 4a. v <br /> Moving Area rd : Soil Type ....�fd ................ v m <br /> Grading .......... Slope ................. ................. O ti ° <br /> Ra <br /> te ate ............. . ................ <br /> Mobile Home 3. Use (describe exactly, 1 -family <br /> Privy me., o garage, motel, etc. Dry Well .... <br /> Well Seepage Trench .......... <br /> ... .................................................... <br /> Subdivision Privy .......... <br /> ......... .................................................... V <br /> Seepage Bed ;� <br /> ---------------------------------------------------- — -----1 X'Z,� ✓�.... <br /> Cn <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road C: <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 LABEL EXISTING <br /> N <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. <br /> I -�...�... ft. x .... ®... ft. — ..... .....��............. sq.ft. <br /> a <br /> r' 0 <br /> N '`^\, O <br /> O <br /> a � o <br /> k N <br /> �: 7 <br /> z <br /> o <br /> DO <br /> CD <br /> �. m <br /> CD cnr g':,m c m �. rr <br /> Z Op <br /> O <br /> ffl — <br /> N <br /> 7� O O <br /> \ -O <br /> Signrur�e Owner or Agent <br /> /` Date X R <br /> Remarks ...C. ...�LG..... .7 .�.1.`... ......................................... ................. ro :baC <br /> ........... .. / .. .::Z?....:...... <br /> ........ .. ................................................................ <br /> Inspection Date .Lc�.? ............ �(� . 4��•zO o cn o Ir <br /> ................................................ O o o rr <br /> ZoningAdministrator 0 0 0 r! <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 plumhinq 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 he made without approval of the Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />