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Burnet County Office of Zoning Administrator o o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> 0 <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 m m <br /> Ordi Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> L G,��.���,� ................. ..................................... = - <br /> .................... _ <br /> O N Kase r tl CDNTR ACTOR or SURVEYOR or AGENT a <br /> 0 <br /> • <br /> ESS <br /> �erL/r T!...�/. .�.^....... 1..... <br /> ADD fir... . . . .............................................................................. d V <br /> rRRI ADDRESS » <br /> _ ___ <br /> �P, s/r.. ......�..r/i...rs� ............................................................................................ <br /> ADDRESS ADDRESS V <br /> . ........ 9........ ........ ......... .................................................................................. <br /> PHONE PHONE ;� <br /> ........................................................................................... . . .WELL D......RIL"I'L,LER......................................................................... <br /> PLUMBER <br /> .......... <br /> .. . . .................................................................................. . ............................................................................... _. <br /> ADDRESS AD.. DRESS � o <br /> ........................................................................................... ............................................................................................ O .i <br /> PHONE PHONE Z � r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> o <br /> New Building �., Type of Construction: No. Bedrooms .......... <br /> Addition ..... .... ........... ,•,,,,,•,,,,,, G ..,,.. Septic Tank Size Gals. .......... <br /> ........... <br /> Sanitary .......... Size ......... I... ft. x ...�....... ft. .......... o . <br /> Filling/Grading .......... HeightStories . A/ 4a. Absorption Field Site: 3 <br /> Moving Area .. . Soil Type ..........:......................... 3 <br /> r <br /> ✓��a...s .: ::::::: <br /> Mobile HomeSlope .................................I........ 1 » <br /> .......... 4 ; <br /> Privy ,•,•„•,,. 3. Use (describe exactly, 1 -family Pere. Rate ................................... n <br /> Dry Well .......... <br /> 3 <br /> Well .......... ho a zaxotel, a Seepage Trench <br /> Subdivision . ,� ....�. / Q�RQ ”"""" <br /> .......... . ..... .�. �. <br /> Priv <br /> Camping unit .......... ... • %4040 -�.............. See ya e Bed .......... o <br /> .......... <br /> ___________________________________________________ Pg_____—_________ <br /> tV N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road W Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. ifi;r rty is coated at a highway inter <br /> section, show the intersecting highways and the setbacks required along them and aA the tart PLY LABEL EXISTING • = <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I 0 <br /> 5. Lot Size: Fig. A. o b (� <br /> ./�..Z . ft. X0 ft. —(5;.(* d..0.)...... sq. ft. ..... .......... <br /> ................................ <br /> p :V\ . <br /> t <br /> N yiJ� O <br /> qi <br /> p/f f <br /> n s /zr 7 it � <br /> S'e,e, <br /> Q <br /> ) <br /> o <br /> (11y- D <br /> 65� <br /> t / c mcri <br /> m c m <br /> 4"0 O p <br /> n � � e 0 :° �� am3 <br /> CD <br /> .... <br /> ............ ...... .7...1..L rlV o C <br /> Si at �/ or A Date X <br /> Rema .1..4.. . .. . .. .. .......' .. .f��.......................................................................................................................... ,� O <br /> m <br /> nn� <br /> ........................................................................................................ .......................... . .. ................ J ut <br /> m <br /> Inspection Date ....................................... ............................. .... .... ....... u v, o U o m <br /> ZoningAd Inistrator is 8 8 8 8 8 8 Vl <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 Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> L <br />