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Burnett County Office of Zoning Administrator i o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < — <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 <br /> :l .cLvanjct.........��t.-1..1a.nz....... ...e ......... ' .a.s.f......................... 7 o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> .S .. .: a <br /> �.za. " ....�.ren. .. ..... 1. ................ ..�f.1......... 04....�.ss ............................... d <br /> ADDRESS ADDRESS <br /> s �.:.... .ra 1.....N1.ri.......ss�o ............... .....s..h.e!.!..... .Q.K.. ,...:I�l-..s,.....s4117.1 = ' <br /> ADDRESS ADDRESS <br /> r��a..-....7...7./....-.....�.......0....4 .................... ........ .6... .-.... o..a..6............................................. <br /> PHONE PHONE M <br /> ............... <br /> ........................................................................................... WEL. . . ..L......I..LL,....ER........................................................ l(� <br /> PLUMBER DR 'W <br /> ........................................................................................... <br /> ADDRESS ADDRESS m 0 <br /> of o <br /> of. <br /> ........................................................................................... ................................................................................ <br /> ............ <br /> PHONE PHONE Z H <br /> DESCRIPTION 4. Sanitary Facilities: ° or <br /> ° <br /> 1. Work: 2. New Building Details No. Bathrooms o ' <br /> New Building .,,�{... Type of Construction: Nq. Bedrooms .......... 'o <br /> Addition .......... ...................yy. .......,............ ...... Septic Tank Size Gals. .......... <br /> Sanitary ........., Size .....;R.fR. ft. x ....a� . ft. .......... ` •' <br /> Filling/Grading „ ,..,.,,, Height............. Storigs ............... 4a. Absorption Field Site: <br /> Mqving .......... Area ...794'.mAf-,.j1... ............... Soil Type .................................... .r <br /> Mobile Home Slope .......................................... e” o <br /> .......... <br /> E <br /> .. <br /> 0 <br /> 3 i <br /> Privy ,,,,.,.,•, 3. Use (describe exactly, i -family Perc.Rate ................................... ' <br /> wail ........., home garage, motel,et ) Dry Well .......... <br /> subdivision •.,,,,,•„ - / Seepage Trench Privy .......... <br /> Camping Unit .......... G4• ....... .......... <br /> Seepage Bed .......... <br /> so <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc., should be sketched in Fig A. Include road L o. <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- t O- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING W <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O o' <br /> 0 <br /> -- --------------------------------- ---------------------------- <br /> 5. Lot Size: - Fig. A. 6. Location: o n <br /> ..v.5.4..P.. ft. x ..�J�..Sft. — ..7h.,,5-,50..... s4. ft. <br /> o N <br /> N O <br /> r �&4 <br /> 0 <br /> Ic <br /> Z <br /> w I o <br /> (no- U N 0 <br /> vi <br /> C F <br /> l p vi; m D n <br /> 0 Op <br /> n <br /> Im <br /> 4nau <br /> ..... ............,............� ... . .. `../f" � C <br /> ofer or Agent ate <br /> `` pp ° x <br /> Remarks .,:JR<!/... ... ..� y.�./. r mm <br /> Ise <br /> ...........-........................................................................................................................................................................... — <br /> n <br /> O: N <br /> ....... ...... ........................ <br /> Inspection Date ....................................... .. .....1W...... .. .:.............. drJ : ,uNi U o umr o u m <br /> Zoning Admini trator, c 8 8 8 8 8 8 rmn <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 marle without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />