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3urnett County Office of Zoning Administrator d o o/ <br /> APRiiCGATION FOR SANITARY — LAND USE — BUILDING PERMIT �* <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 7 -ti <br /> ;hewn herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD c <br /> ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis sin. a ; W <br /> / y <br /> { .t',it.n...... .Cr... !�u........................................ �cxl�...... g.. .. Q.Y. ........ 0.� ................ <br /> 0 <br /> DWNER (please print) CON RA TOR dr SUI�OR or AGENT Q V CD <br /> CD <br /> ..t........./ f... ........... 1.�.K........?...t...................................... Q <br /> .................. o� <br /> 4DDA ADDRESS <br /> . .i, ✓ .b. . .r................. �.a................... G �'.:�0 . .: .............� .. ..% .. <br /> -- <br /> �. .. ............ ...�S <br /> ADDRESS ADDRESS ~� <br /> .' � �. ........ ... .. 1../.......................................... � .. ... .. ......................................................... <br /> 'HONs7. PHONE �1 <br /> ......................... ............................................................................................ <br /> 'LUMBER WELL DRILLER <br /> A.......RESS.. . ................................................. <br /> ........ <br /> ...................... m L) <br /> ADDRESS DD <br /> h o <br /> < <br /> o ,-: <br /> PHONE PHONE z N r <br /> DESCRIPTION 4. Sanitary Facilities: s��� ° v ° <br /> 1. Work: 2. New Building Details No. Bathrooms /.......... ^�: o <br /> New Building Type of lonstru tion: No. Bedrooms 0 <br /> ... � . .. <br /> AdditionP.R.e........ �am �. Septic Tank Size Gals. �2ob ; <br /> ......... <br /> Sanitary Size dlq........ ft. x ..ZC'. ft. ......"'. <br /> L <br /> Filling ..,,,.,..• Height............/. Stories ...�..Z.... 4a. Absorption Field Site: •C <br /> Moving �O Soil Type .................................... CS r— <br /> Area ........ .. .. . .. n. <br /> GradingSlope .......................................... <br /> ......... <br /> Perc. Rate ........... �7j.......... 1 <br /> Mobile Home 3. Use (describe exactly, 1 family (� <br /> Privy .......... home,garage motel, etc.) Dry Well <br /> Well L'vsf .. ..fq?�' ..�. .... -t�........ Seepage Trench `....... ^ J <br /> Subdivision Privy .......... <br /> .......... <br /> Seepage a e Bed uP (� <br /> ---------------------------------------------------------------------- rW CA <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road 6 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- M Q <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ( hJ < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ----------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: y <br /> .�.�..�.:.7.� ft. x ........... sq.ft. ............................................................................... a '� <br /> g Acre;, <br /> :c Cn <br /> CD <br /> :3 <br /> N O <br /> o :s <br /> 0 <br /> CD <br /> �- <br /> � 6 ' 6 � 0 <br /> CD <br /> �V <br /> Co cnooz <br /> EID <br /> L N Q 0Q-< — ;7+ <br /> rn <br /> 3• prn <br /> _... � � z oo `D � � <br /> LC <br /> A <br /> Signature of Owne or Agent Date C <br /> Remarks .�a�..�..�.3.37 ........................................................................... � x : : m <br /> CD : 0 <br /> ........................................................................................................................................................................................ <br /> ......................................................................................................... ......................... t <br /> ............................ ................... . <br /> Inspection Date ....................................... /- 00000 <br /> ................. <br /> Zonin9 Administ ator 00000 0 <br /> VOTE: 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 /> :his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> Nith 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 />