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Burnett County Office of Zoning Administrator c _ --IZ <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT h' 3 a <br /> r' o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as v, <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a a <br /> * a <br /> �fi��� E So.CdF2 .L E-E7�+-/1/l�,CJEir _ o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .............................. ............................................................................................ <br /> ADDRESS ADDRESS + <br /> i tiF6sT�=.e wZ sy�9 ,3 - <br /> ...................................................................... ......................................................................................... <br /> ADDRESS ADDRESS <br /> /1�?Gs....�i /-.�s��.... ......... .s1.7 ........ <br /> PHONE PHONE / <br /> ................. . . <br /> .............. ..... : . <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS <br /> o <br /> PHONE ............ o <br /> ................... <br /> PHONE <br /> z y <br /> DESCRIPTION <br /> 4. Sanitary Facilities: 2. o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> v <br /> YY o <br /> New Building ...r.,.. Type of Construction: No. Bedrooms .......... -0 <br /> C <br /> Addition Septic Tank Size Gals. ..........Sanitary .......... Size .............. ft. x ft. ......•••• <br /> Filling Height............. Stories ............... 4a. Absorption Field Site: <br /> MovingSoil Type .................................... <br /> .......... Area °r <br /> GradingSlope .......................................... — <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Dry Well ' <br /> Privy ., home, ara e, motel, etc. ......•"• <br /> g 9 1 <br /> Well e W S'�$ Seepage Trench <br /> ...........................................I........ <br /> Subdivision .......... Privy .......... <br /> .................................................... Seepage Bed ......... <br /> ---------------------------------------------------------------------- cn <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- _a <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. y <br /> o <br /> ------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: Imo). <br /> [a7� / Se'c i S <br /> ................ ft. x .............. ft. — ............................... sq. ft. ..�TP.Y.�:...........yr.........�.....,�.��4.��/s"W...... . _ � .%A c <br /> N <br /> o <br /> do <br /> 3� <br /> 1 -n <br /> CD <br /> Z <br /> 0 <br /> m <br /> m <br /> sC CD <br /> 3 7 cnr - cnco_ ,. <br /> -o cn<,C: <br /> Z C)E5 CD <br /> `° <br /> o � <br /> .................. 3- � - CD p <br /> signature of Owner or Agent I. Date 1- ° C <br /> Remarks ..�1.]r!.4�CL�f� ...................................2c4 e.= :�.t.. .�s.. �cich r. ...5`� S/��t..... °"�....................... T m <br /> / / / / - x C <br /> ...... �tC[�i $i cha' rJjn ur/� Cd4� ^' C+�L ry �r✓ r�� <br /> /^ / <br /> CD <br /> �/. r............ . . ... r!........ ............. ............ ....... ........ ....... <br /> ....... �. �.. . -- <br /> U GLr!�. .........�—I�...� l ....''...4�.AL.(..... ...4.hJ ...a.... .-f.......Q. ry <br /> o. o � <br /> o: <br /> ection Date r?�'Z ,Gp o 0 0 0 o cn <br /> ns m <br /> p . ......... ............................�... .............. 0000co <br /> Zoning Administrator o 0 0 0 0 o y <br /> OTE: A preliminary site inspection must be made nd site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />