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0?' nI I . <br /> Burnett County Office of Zoning Administri for <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 11, A, <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 , <br /> regu)�tions of the State of isconsin. <br /> .....LLn ` .... ................................ 1 Cc�iX' r.................................... A ^ 47p <br /> OWNER (pleals print) CON ACTOR.dr SURVEYOR or AGENT <br /> .,... . ......� Q�L...J.Q............................ ....... dN <br /> ADDRESS AD ESS <br /> if' .. .... ... ! .7 ............. ....... <br /> ADDRESS ADDRESS <br /> ....... ....... <br /> ........................................................................................... . ........................................................................... <br /> PHONE PHONE <br /> PLUMBER............................................................................ .WELLDRILLE.R.................. <br /> ............................... <br /> ....... ..... '. IJV <br /> ........................................................................................... 'A"6DRESS......... .................................................................... ....... O <br /> ADDRESS AD � c <br /> =. < <br /> . . o <br /> PHONE PHONE Z r .1 <br /> DESCRIPTION 4. Sanitary Facilities: Po ° J_ <br /> No. Bathrooms ' <br /> 1. Work: 2. New BuildingDetails """"' <br /> Bedrooms N"Building Type of Construction: No. ' """" ' <br /> Addition Septic Tank Size Gals. . ........ <br /> Sanitary Size .............. ft. x .............. ft. . ........ <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Area ...........................................Moving Soil Type ............................ ... <br /> Slope ......................... ...... ............ <br /> Me Home ....... . ro <br /> » <br /> Perc. Rate .......................... ........ m <br /> Privy .......... 3. Use (describe exactly, 1 -family n <br /> ; <br /> m Well . ........ <br /> Well .. ... home,garage, motel,etc.) Dry — <br /> Seepage Trench o ' <br /> Subdivision ,.. .................................................... Priv . ........ <br /> Campingunit .......... .................................................... Seepage Bed v O C <br /> ------------------------- --------- ----------- --- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in F g. A. :C. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is locE ted at `CU1 UJ - <br /> v� Al : <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the interse tion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. {N w <br /> --------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: 0 znj vJ: <br /> ......... ft. x .............. ft. — ............................... sq.ft. ........ <br /> N 0 <br /> J o W <br /> 0 <br /> 0 <br /> f <br /> s <br /> o' <br /> Z -, <br /> ]7 <br /> a <br /> e <br /> >m <br /> V <br /> M c m m n 03 co 1101 <br /> c — — m <br /> m Na'< — o- m nn70 <br /> a o< c y 3 <br /> 0 <br /> Zoo 'Z D <br /> P �� U) A <br /> 0 <br /> 14 c C <br /> A : m <br /> ........................................................................... ...................................... a O <br /> Signature of Owner or Agent Date o a <br /> o , <br /> Remarks m i y <br /> a <br /> j = N <br /> ................................................................................................................................................................................ ....... <br /> 0 <br /> o . o0 <br /> o <br /> ................................................................................................................................... .......................... .. .... T <br /> Inspection Date . <br /> ....................................... •fi +! . • . /�11., cn of u, o o an m <br /> J�J Zoning Administr or e..N71 9o 8 8 o o $ W <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary acilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this ap Iication 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 N en issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans r 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 />