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Gid"C L'-77�/p <br /> Burnett County Office of Zoning Administrator W c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and •2 qy� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,$ t <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 'v <br /> regulations of the State of Wiscon n. <br /> 6aN . , i �c?... ?.. Q.!(�................... . ....... . . . . ........................................................................ 3Q <br /> OWNER (pia%"print) CONTRACTOR or SURVEYOR or AGENT ' p <br /> n <br /> I .i.. t.......e:*........O.��:.V...�.......... ............................................................................................ d � <br /> AD ESS ADDRESS <br /> t �.s. .T-:U/r... ....M. 1.- <br /> 537............................................................................................ _ 1 <br /> ADORE ADDRESS <br /> ................. .PHONE W • <br /> �k.�V........ e ............... <br /> PLUMBER WELL DRI Rj <br /> ........................... 0 <br /> ADDfl ESS ADDRESS C <br /> +. < <br /> . . .................................................................... 'P-14-0-*N* .................................................................................. - <br /> PHONE NZ H » - <br /> DESCRIPTION <br /> r <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> New Building Type of Construction: No. Bedrooms c <br /> ' 0 <br /> .......... <br /> Addition Septic Tank Size Gals. .......... <br /> ..,,�.i... .............^^. . ....... ........ .. . 2 <br /> Sanitary Size ....R ft. x �. . ft. .........• <br /> .......... ... <br /> Filling/Grading ,,,,,,,,,, Height. ,r$ rtesr�.... <br /> 4a. Absorption Field Site: <br /> Moving ..... .... Area �Cy.y.d �...7.�,+ Soil Type .................................... E r <br /> Mobile Home 9 Slope •» <br /> o <br /> Privy .. 3. Use (describe exactly,'1 -family Perc. Rate ................................... <br /> 'fll�Y• ho e,gar e, mot,et .) Dry Well .......... m <br /> Subdivision - �/ Seepage Trench .......... ? <br /> Camping Unit .......... Privy .......... <br /> ............................. ...................... Seepage Bed <br /> ---------------------------------------------------------------------- i <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 back yard dimension and location and setback from all bodies of water. If property is located at U) <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. f o <br /> -------------------------------------------------------- -- <br /> 5. L t ize: Fig. A. 6. Location: <br /> .. (!.. ft. xt.l..�.. ft. - .....> .4'.fi.4r.... <br /> sq.ft. ............................................................................... <br /> A13 <br /> NftJ WCLL 1v 9E <br /> i9y °RZ LLE <br /> yZ <br /> 0 <br /> 107 r4wS <br /> M ;U) -0 cn r— > co <br /> m Ui Z co a m s ic <br /> S <br /> m <br /> A M <br /> j11.... .. . .. ...... .............. .......� m <br /> SigA f n r o Ag nt Date <br /> Remarks .... .... ... .. ... . .L�:......�'f�. A,r.W y..t'.s... ... ...:�. .. .. ... ./l.( .....:J..Q........ <br /> - .... �... . ... . . N <br /> a <br /> ...r ...... .. . .. .. .�' 7qJ .. . r. . .....n. .. . . ....(•.S,r....../."1�1r:{�i.............. <br /> ..... ....r..................Y..... ..S/jyil. ....��'!�,r71 i�........... .. ... ................................................. e <br /> o ; <br /> ............... , o <br /> " W N m <br /> Inspection Date ....................................... J� 1.. .........!}..U: ... ........ � u, v. u _ o v, m <br /> Zoning Ad i istrato4"' 8 8 8 8 8 N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construct; <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 />