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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE -- BUILDING PERMIT <br /> o <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 <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a W <br /> r+ :_J0 <br /> N.. CD <br /> N (p : <br /> ....... ............................................................. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> CCD <br /> a <br /> !.?...�. .... F.. ......................... ......................................................................................... <br /> ADID RESS ADDRESS ' C� <br /> T.P,�. .�.... r� ..... 7........... <br /> ADDRESS ADDRESS u, <br /> l�r 'o .o... ..... .. z� , ,�1�►! yA .......................................................................................... <br /> PHONE PHONE <br /> .......... <br /> PLUMBER WELL DRILLER <br /> v <br /> ADDRESS................................................. ...........:.. ADDRESS............................................................................ 0 o ; <br /> ........................................ .......:............................... O o <br /> ............. 0 <br /> PHONE PH..ONE...... <br /> Z H r <br /> DESCRIPTION 4. SanitaryFacilities: O �* <br /> No. Bathrooms <br /> 1. Work: 2. New Building Details """"" o <br /> New Building ...!...... Type of Construction: No. Bedrooms .......... m <br /> Addition .................................................... Septic Tank Size Gals. <br /> .......... <br /> Sanitary Size f�,�l.14 ft. x ......... ft. """"" <br /> .......... ..... . . <br /> Filling .......... Height ;7 Stories ....... 4a. Absorption Field Site: : <br /> g ,.Q ' Soil Type .................................... `• ? o <br /> Moving Area ........ . �/ .... <br /> GradingSlope .......................................... �+ <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... ()v i E <br /> Privy home,garage, motel, etc.) y <br /> 9 9 Dr Well .......... <br /> .......... . . . <br /> Well .L.�l�....c / ........ Seepage Trench <br /> .......... <br /> Subdivision .......... Privy o <br /> Seepage Bed s2, <br /> ---------------------------------------------------------------------- CS? 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- o <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING y <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> -------------------------------------------- ------ ----- --- <br /> 5. Lot Size: Fig. A. 6. Location: �}—/ <br /> �.��?.:...7 ft. )j.Z1' t. — ...:..... ... ............... sq.ft.. 1.....!�..... ........ <br /> O <br /> I� ijv <br /> -� <br /> N O <br /> i O 7 <br /> 7 :W <br /> r Z <br /> o <br /> CD <br /> cnr -0 (ncoZ <br /> fp c =• fp C (D <br /> CD N a a•< n <br /> a cn< C <br /> QVl N •< M <br /> 0 C5 <br /> Ln <br /> o� o <br /> o ':R17� <br /> 0�... ... v p <br /> o � C <br /> Signature of Owner or Age Date <br /> '7 <br /> X <br /> Remarks..,,]..Cl��?�?!�.rw�...��..�0.5.".9...7..�...��,��.3..�!..�a.�:a�......................................................................... � v <br /> m <br /> ........................................................................................................................................................................................ u <br /> ........................... <br /> O O O O O O T <br /> Inspection Date > ...`.....:.....g................ ........... ......... p o o m <br /> o00 0 <br /> Zonin Administrator <br /> y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with 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 />