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Burnett County Office of Zoning Administrator v CD o 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 '� H * :(-,3 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 o.. \ <br /> -. .w. x �... ....., !?. .,5�. ............ lsu .�� . ..��.n.-.cut.../f..fi//j, � /. ��..... <br /> OWNER (please print) CONTRALT.O or SURVEYOR or AGENT m v <br /> 1IY3....G/. .uz./G.e .s-f...A)� :s..7.�..1?4,..,3.... d ...3d.............................................. 1 <br /> ADDRESS �/ ADD/ SS / _ �* <br /> ;,V" �y <br /> /.. , .... ... ... .7.. '7d.................................... ?.�s)... .s`..:: s ...................................... 43 <br /> P E P H NE <br /> :z <br /> .......... <br /> ...W............I..L......R........................................................... <br /> PLUMBER ELL DRLE :n <br /> ........... <br /> .......... .A......RES"'E*S.S................................................................... _. <br /> ADDRESS DD 0 o <br /> f+ < <br /> ............................................................... ........................................................................................... o <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> Ttl <br /> 1. Work: No. Bathrooms ......... <br /> 2. New Building Details ° <br /> No. Bedrooms L <br /> New Building ...X... Type of Construction: //�� "'•'•"•' CD <br /> 0 • <br /> Additionc�,J�,q ;� W,�S��K•'�!Qc; Septic Tank Size Gals. <br /> .......... <br /> Sanitary Size � """"' iA <br /> . �� <br /> Filling 4a. Absorption Field Site: <br /> ........• Height....<r..... Stories+..../.... <br /> Moving .......... Area ...2.,1 .s�...:f�. ..... Soil Type .................................... Oi ' <br /> Grading Slope .......................................... �. <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Dr We <br /> Privy .......... home,garage, motel, etc.) y t <br /> Well �} <br /> Well Seepage Trench ......... �l N <br /> �i.143:�............................ <br /> Subdivision .•„•.•••• Privy €� <br /> Seepage Bed .......... v� <br /> ---------------------------------------------------------------------- C' Cn <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road .��' a <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- � <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING rJ y <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ------------------------------------------ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ......`.......5�....... sq.ft. :— <br /> co <br /> :o <br /> o '►� ° <br /> :o <br /> I o 2 <br /> N <br /> • i <br /> Ln <br /> Z <br /> � o <br /> 1 to <br /> W m <br /> T9 <br /> r 1 <br /> CD <br /> 3 <br /> ECD <br /> --� �- m. N Q �.< Q <br /> m <br /> z 00 `D 70 <br /> }� m <br /> m <br /> s _ by <br /> Signatur�of Owner or Agent Date <br /> X <br /> c i :c <br /> Remarks ......................................................................................................................................................................... �t� m� <br /> CD <br /> y,; n <br /> .......................................................................................................... ...................... ............. ........................................ . <br /> �f O O O <br /> Inspection Date ....................................... ��?zz(�...... ....%....... . . ' ' : . 0 0 0 ' o <br /> Zonin Admi istrator O O O O O V) <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />