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cs <£_ 7` <br /> 77 ?- C <br /> Burnett County Office of Zoning Administrator C vz/ <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 p <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < -F o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> ....... ... .. ........ .............................. ........ y <br /> OWNER (Please Prin 1 ................................................................................ 'r <br /> CONTRACTOR or SURVEYOR or AGENT CD CD <br /> 't g <br /> 1 <br /> 4DDRESS ........ s... ...................................................... <br /> ADDRES..S <br /> ,Ct7STCe V 'S h. <br /> 4DDRESS ......................................................................................... <br /> ADDRESS _ r <br /> 'HONE PH..O..NE.... NLI <br /> .........................!......'............................................... <br /> 'LUMBER ............................................................................ q <br /> WELL DRILLER <br /> p <br /> .......... <br /> aDDRESS ... ••.................................................................. <br /> ADDRES•. •••...S Cl) o <br /> P..•.HO..N......................................................... — <br /> 'HONE E ............................ o �; <br /> z N DESCRIPTION � <br /> 4. Sanitary Facilities: ° o <br /> I. Work: 2. New Building Details No. Bathrooms 6 <br /> ......... . . <br /> New Building Type of Construction: No. Bedrooms ° <br /> ,2 <br /> Addition jc . . <br /> .. .................................................... Septic Tank Size Gals. .7..? <br /> Sanitary Size •..,3.h...... ft.x /.1...... ft. .......... <br /> Filling Hei ht Stories 4a. Absorption Field Site:g .............. E <br /> Moving .......... Area ........................................... Soil Type .................................... r E <br /> Slope � <br /> Grading .......................................... ° <br /> .......... <br /> Mobile Home ..•......• 3. Use (describe exactly, 1 -family Perc. Rate ................................... ; <br /> Privy .•..•..•.. home,garage, motel, etc.) Dry Well fi <br /> Well ,a,u,ri,r„.... Seepage Trench ••........ <br /> Subdivision �/ """ " """' <br /> Privy .......... <br /> ....!......y l...G... .. ........................... <br /> -------------------------------------------------- Seepage Bed--- ......... J �:_ , :N <br /> ocation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road �J C <br /> etback, side and back Cr <br /> yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a � <br /> action, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5 <br /> TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> O <br /> ------------ ------------------------ <br /> Lot Size: Fig. A. 6. Location: <br /> T ... ft. — ` c <br /> m <br /> c <br /> L 4' 3 <br /> A <br /> u� <br /> I � 0 <br /> I y <br /> ,v <br /> o <br /> � co <br /> LTD <br /> cnr - cn z <br /> CID CD 2. Mdc <br /> CD N a n. <br /> m <br /> IO v; f G m <br /> D Z oo fD D 70 <br /> CD <br /> tu'r'..... . .........•..................................... <br /> ....... <br /> mature of�wner or Agent Date ° <br /> X i 7l7 <br /> marks ... .....`2eR- - O <br /> .................................................................................................. m <br /> t <br /> ........................................................................................................................................................... ....................... <br /> -- <br /> .........................................................................................1..........(. .. ................,.D..... <br /> ...`................................................ <br /> ;pection Date ....................................... may ..1 " . !.. .... o m <br /> \° , — , � <br /> 0 0 0 0 0 <br /> Zoning Admi istr for 0 0 0 0 0 o cf) <br /> TE: A preliminary site inspection must be'made and site approval granted on all structures involving sanitary facilities <br /> ore construction can begin. In the case of serage disposal systems, a copy of the percolation test must be attached to <br /> application before a permit will be issued. not purchase or install a septic tank, do any plumbing or start any build- <br /> until a permit has been issued. A permit may be rkoked if misrepresentation of any of the information conveyed here- <br /> h 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 />