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,•�, �,v s f- cc ti1� p b /o -/y- 8S' <br /> Burnett County Office of Zoning AdministraG o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <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. I CD :ti <br /> y a �'.N <br /> m A1....Blaam�...........Ye.l.low...R.iv�r•....Zr�r�..... (b v <br /> N ,� <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT CD _ m <br /> a <br /> �!{IP_hS•tee...,....W-I......5.489.3.................................. ............................................................................................ CL <br /> ADDRESS ADDRESS r. <br /> ....... ............................................................................ <br /> CD <br /> N <br /> ADDRESS A03 <br /> DD.. RESS.... � <br /> i-� <br /> .......86.6.... . A, <br /> PHONE PHONE Gp <br /> Dpn.a•1�...akn•iels............................................. ......................................................................................... � <br /> PLUM R WELL DRILLER w <br /> }{ ..W.........S-iren3 ...W1......5D1I.8.`7- -2................. <br /> ADDRp ESS ......................................................................................... <br /> ADDRESS <br /> CD <br /> P--6-J 1.5• 349g 5.364...©r...46-3-23.3.3................. PHON.E................................................................................ � � < Q <br /> DESCRIPTION o '+ o <br /> 4. Sanitary Facilities: o <br /> 1. Work: 2. New Building Details No. Bathrooms 2 '� <br /> New Building .......... Type of Construction: No. Bedrooms <br /> Addition Septic Tank Size Gals. .......... <br /> 2 10 000 :U P <br /> SanitaryHolding tanks ....s.... <br /> ..X..... Size .............. ft. x .............. ft. <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... r— <br /> .......... ........................................... ;x <br /> o <br /> Grading ........ . Slope .......................................... o• :N. �. <br /> Mobile Home Perc. Rate ................................... 3 bq <br /> 3. Use (describe exactly, 1 -family �Privy :�- <br /> .......... home,garage,motel, etc.) Dry Well .......... :F <br /> :WWell Seepage Trench <br /> „••,,,••• <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 :2: <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway W a <br /> P P Y 9 Y inter- � <. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING O <br /> :0 N. <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o' <br /> 5. Lot Size: Fig. A. 6. Location: :(D <br /> ................ ft. x ft............... — ............................... sq.ft. ............................................................................... C to <br /> a <br /> :rD <br /> :'-s <br /> cn <br /> :a <br /> 3 oa <br /> 0 <br /> 0 <br /> 7t:� <br /> z � <br /> 0 <br /> LM <br /> M <br /> rn <br /> �o cn 'n Z <br /> C ¢> <br /> CD <br /> '0 LnN <br /> bCD <br /> . * m <br /> z o o'fD m 70 <br /> o _. <br /> �o <br /> 10/21 /8 3 <br /> 'D p <br /> signature of Owner or gent Date ° ` C <br /> X M <br /> 3emarks m c_ i m <br /> CDCD <br /> v <br /> ......................................... ......................... <br /> ..........�..................... ................................... :: .......................... ................................................ <br /> — o 8 <br /> nspection Date ... 1 —�� �rtGp� 0 0 0 m <br /> .9......... ............. <br /> Zonin Ad inistrator ear o 0 0 0 0 o CCn <br /> OTE: 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANIJ APPROVED. <br />