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3urnett County Office of Zoning Administratord 0 0 <br /> 1 <br /> APPLICATION FOP SANITARY — LAND USE — BUILDING PERMIT d 3. : 1 <br /> -O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as Z <br /> hewn herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> )rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> a <br /> &N..A.RD........k✓!.L..s:�.!✓. .................................. .......�� . ...It ....1'. .u.. . -s.............................. N <br /> )WNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> yo°g... .�...r�..R..l.4 H..................................... .............. E aQ s 9 A1C W.!..5.................... a <br /> tD6RESS ADDRESS <br /> ................. ................. ......................................................... ... ..I...................... <br /> kDDRESS ADDRESS :\ <br /> 1. ... .8.7.9.. -....ao77 8(,G - g�-5o t� <br /> .............................................. ............................................................................................ <br /> 'HONE PHONE <br /> .......... <br /> ....................................... ........................................ <br /> . . . . -I-L. ............................................................... <br /> . <br /> 'LUMBER WELL..'D-R- ;`` <br /> A.....DRESS...................................................................................... O <br /> ADDRESS D � .M • <br /> .............................................................................. P.... .............................................................................. 0• <br /> 'HONE HONE <br /> ......... y <br /> DESCRIPTION Z r <br /> 4. Sanitary Facilities: ° 0 ° <br /> Work: No. Bathrooms .......... �i T <br /> 2. New Building Details o <br /> New BuildingType of Construction: No. Bedrooms .......... m <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary ,,,,,,,,,, Size ....LL.... ft. x .... ... ft. ....... - <br /> Filling Height............. Stories ......I....... 4a. Absorption Field Site: O E <br /> Moving .......... Area .......3.S.2..4... ... ...: <br /> .... Soil Type .................................... <br /> . <br /> o <br /> GradinSlope ............................ ............. 6� i <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... E E <br /> Privy .......... home,garage, motel,etc.) Dry Well .......... ,� E <br /> Well Seepage Trench <br /> E <br /> SubdivisionPrivy , <br /> .......... .................................................... <br /> Seepage Bed .......... C4 <br /> ---------------------------------------------------------------------- tN N <br /> .ocation of proposed structures and existing structures,well,sewage systems,roads,etc., should be sketched in Fig. A. Include roadtJJ Q <br /> �tback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ^ o• <br /> action, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. T. <br /> ------------------------------------------------------- ---------- <br /> i. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> P <br /> N <br /> e <br /> N N o' <br /> o <br /> 1�, N <br /> 7 <br /> S <br /> a <br /> L _ / <br /> / you V i h� z Z, <br /> � v <br /> c d-0'n <br /> �tJ 3 < -� <br /> m. ,V d 0- <br /> Ln C <br /> J Z o o `D `D <br /> o <br /> o E . -1 <br /> : : <br /> . ......... . . . . . :c� -................ ...s . .............. . .� c_ <br /> i ature of Owner or Agent r ate ° <br /> >< <br /> ...................................................................................................................................................................................... <br /> II <br /> ...................................................................................................... .. <br /> . ..... ............................... <br /> nspection Date ....................................... t l� . ...:.... .. .......... .............../C J.......... 0 0 0 o cn m <br /> Zoning Admi istrator o 0 0 0 o cm/s <br /> DTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> (fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> is application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith 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 />