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_'h <br /> 3urnett County Office of Zoning Administrator C - o o ` <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> o <br /> FO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N :W <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseCD c W <br /> Drdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a W <br /> �• .. � / '��........................ S F� <br /> y w <br /> gWNER (please print) w / CONTRACTOR or SURVEYOR or AGENT a 7 <br /> r <br /> ADDRESS ADDRESS m :I <br /> ............................................................................ ............................................................................................ :� <br /> ADDRESS ADDRESS <br /> ................................. ................................................ ............................................................................................ <br /> 'HONE PHONE <br /> ......``.....!..!�!7`..:................................... .................................................................. <br /> 'LUMBER WELL DRILLER <br /> ADDRESS ADDRESS <br /> h o 1' <br /> ............................................................... _ < f <br /> 'HONE PHON.E....................................... ....................................... o r+ •hy <br /> Z y <br /> DESCRIPTION 4. SanitaryFacilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details "" •"' 1 <br /> o <br /> New Building ...x Type of Construction: No. Bedrooms „ ti <br /> m <br /> Addition ..4i �sJ,1>,,, i�' �j Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ..c24?..... ft. x ... .... ft. ""•"'" <br /> Fillin 4a. Absorption Field Site: <br /> g .......... Height.....�.... Stories ....j......... <br /> Moving ••••••Area y Soil Type ................ U> <br /> Grading Slope .......................�Zj...a...... :\ <br /> .......... <br /> Mobile Home Perc. Rate ............... ................... <br /> .......... 3. Use (describe exactly 1 -family <br /> Privy 7(..., om garage, motel, etc.) Dry Well :F <br /> Well Seepage Trench .......... <br /> .......... /..'.. ' <br /> Subdivision 6-46._.).................. Privy <br /> Seepage Bed .......... iy <br /> ------------------------ ———————— ——————————————————————— <br /> v .N <br /> _ocation of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road Ury <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- CL <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING t� 'Qs <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. \ p' a <br /> ------------------t. ---------- <br /> i. Lot Size: Fig. A. 6. Location: <br /> 49 ...... ft. x .. ?.. ft. — .....1 1 ..... sq.ft. �UG/1...t ..........`f <br /> Cn <br /> 0 <br /> TD <br /> � f <br /> • CQ �, <br /> 8111 <br /> 7 <br /> CD <br /> 0 <br /> m <br /> N <br /> CD �m d C: Co <br /> 'C)°. r Q o < ;7+ <br /> m m <br /> Lo <br /> O <br /> O � <br /> � m <br /> . „ <br /> iignaure of Owner or gen Date :N — <br /> X 70 <br /> 3emarks ..... ..... m i m <br /> erg is .J...... ...... �� �-:A- fsUr o <br /> ........�^.. .. . ...................... ..................... ....�.............................. .. ... ........... ........................ <br /> ....... .`........... ......e 1 .......... .................. o : '..... ....... <br /> Inspection Date ....................................... _ ----__ ° : o 0 0 0 cM rm <br /> .... .... ....... .. A <br /> o000 <br /> Zoning Administr or �- o 0 0 0 o 0 <br /> OTE: A preliminary site inspection must be made and 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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />