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- <br /> Burnett County Office of Zoning Administrator d 1 o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <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. a <br /> .............L'. .h.errr.y...... a... .. .................... ............................................................................................ = <br /> OWNERleaseprint � CONTRACTOR or SURVEYOR or AGENT <br /> K..4tlfa .. ... ... .. ..... .......�a.................... ............................................................................................ ° <br /> ADDRESS \Ar rI ADDRESS <br /> !.. {.....VV..!5........... .................................73 � <br /> ADDRESS ADDRESS ' <br /> ,q - a3 a-y <br /> .... .... ..... ...... ... .... ...... ........ ...... ..... .. .... ............. ... . ..... .... .... ...... ..... ..... ... ... <br /> PHONFj/� PHONE <br /> ........................................................................................... .WEL.. L........DR....I...LLER..... ..................................................................... <br /> PLUMBER <br /> ........................................................................................... . . .............................................................................. �_ � <br /> ADDRESS ADDRESS C) <br /> < <br /> ........................................................................................... ............................................................................................ o' • <br /> PHONE PHONE Z N c- <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1, Work: 2. New Building Details No. Bathrooms .......... o ip i <br /> New Building ...,,..,,, Type f C nst tion: No. Bedrooms .......... 'o V� <br /> Addition v C< Septic Tank Size Gals. .......... <br /> !�.. .......... <br /> Sanitary .......... Size ...^�+ �y ft. x .... ... .. ft. <br /> FillinglGrading .......... Height.. . . Storie <br /> I 4a. Absorption Field Site: . <br /> Moving4 Soil Type ....................... ............ I r <br /> .......... Area .... .. . ... .. ... ............... <br /> Slope ° <br /> MobileHome .......... .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well ......I... home,garage, motel, etc ) Dry Well .......... <br /> Subdivision .......,,. Seepage Trench .......... <br /> ......... .... <br /> Camping Unit .......... Privy .......... © <br /> ............................ <br /> .................. Seepage Bed .......... ^ <br /> ---------------------------------------------------------------------- <br /> Locaumn of proposed structures and existing structures, well, sewage systems, roads,etc, should be sketched in Fig- A- Include road I e <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwayInter- <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. u, <br /> o <br /> ------------ ----------------------- — -----------------------------_ _—._ <br /> 5. Lot Size: Fig. A. 6. Location: ,rt <br /> ................ ft. x .............. ft. — ...... ........................ sq.ft. ..................../«.?....'. !.r..C................................, :a . <br /> / i <br /> d uf�3b ALU ip/'ter � � `t <br /> F <br /> n�c _l <br /> II( z <br /> 1 - - - - :3 `r <br /> n; <br /> 0 <br /> 0 <br /> v <br /> E <br /> / X m r no W W 2 <br /> Nd W <br /> PP D <br /> Z c' a m <br /> 0o g <br /> o am 3 <br /> ' Ilk. p m <br /> .............. .................... .... ............................. .. .......... �.. ......1.0 � Ay13'tPi19'� o C_ <br /> Signatur of Owner or ent I `�� /ate �r W� I — 70 <br /> X <br /> Remarks T : m <br /> ..................I. .......................A.......................................................................................................................... <br /> ........................................................................................................................................................................................ — . . . . . <br /> ?� n <br /> ........................................................................................................... . ............. . .................................. � m <br /> �,/,/' w <br /> Inspection Date ....................................... .....�1 .......... ' �: U ren . �rp m <br /> . ........ . . .. <br /> Zoning Adminis ator �� o 6 0 0 0 0 N <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 dry 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 Ife made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />