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.LI _<1)J �. t: >> <br /> Burnett County Office of Zoning Administrator v _ ZY <br /> M o c <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. 3 a :C <br /> P�A4C�. _ <br /> /.A/d2��T!�i�r, .4..........Bsvit �'�1 5 �'x C- o <br /> N G <br /> OW ER (Please print) ..................... . .... ...... .... .................... � _ <br /> CONTRACTOR or SURVEYOR or AGENT CDCL <br /> ce <br /> ...........Rt. .................................................................. . '...1....................................................................... <br /> ADDRESS ADDRESS <br /> r` �. �y CD <br /> CD <br /> ADDRESS <br /> ..... AS/S� !i.!L.. ..........f..r�i.�........ �� �... lrl <br /> ............ :\ <br /> PHONE PHONE � �Nk, <br /> PLUMBER WELL DRILLER , <br /> v <br /> ADDRESS ADDRESS CD <br /> < ; <br /> .............. p <br /> PHONE PHONE _ <br /> DESCRIPTION o r <br /> 4. Sanitary Facilities: o ° <br /> 1. Work: No. Bathrooms � <br /> 2. New Building Details .......... <br /> ° :� <br /> New Building ..✓, Type of Construct' n: No. Bedrooms .........: -a <br /> Addition ...•„•.. �,�,�c�u�? .•J.F r....... Septic Tank Size Gals. ......... ji M <br /> Sanitary .......... Size .....oX,;2_ ft. x ...1R1I.'7 .. ft. <br /> Filling Height...l.2. Stories ...f........... 4a. Absorption Field Site: <br /> Moving ......... Area ........,� .. ... /Q1 �.... Soil Type .................................... <br /> r <br /> Grading Slope .......................................... ; ° <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy ....•..... home,garage, motel, etc.) Dry Well <br /> Well `9 .#.!� `.............................. Seepage Trench <br /> v Subdivision .......... • " • Privy <br /> Seepage Bed ......... <br /> ------------------------------------------ <br /> Location of proposed structures and existing structures,well,sewage systems, roads etc.,should be sketched in Fig. A. Include road ^ C 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 < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> r °. <br /> ------------------ <br /> 5. Lot Size: Fig. A. 6. Location: X <br /> .. / L�... ft. x . — T n ��l�c ... ft. ..... .���.. ?�J ..... sq.ft. .........S4!.4r;1A........./.'.0. `.� <br /> m <br /> CD <br /> n <br /> N <br /> ° <br /> _ <br /> JD o <br /> ioCD <br /> _ <br /> �d C W W CD <br /> CD. N d a ' <br /> a <br /> t �r a o,< C. _ <br /> m <br /> EP <br /> Z O o' CD <br /> o <br /> d..r....../C�.. . ,. .............. m <br /> by <br /> iign ture of Owner or Agent Date ' C <br /> X <br /> iemarks ......................................................................................................................................................................... m c ' ' m <br /> CD <br /> CD <br /> v <br /> ....................................................................................................................................................................................... <br /> .......................................................................................................... .. ..... ........................................... <br /> nspection Date <br /> Y��.� o00 ocNr m <br /> Zoning d�X inistrator : 1 : 0 0 0 o o m <br /> m <br /> OTE: A preliminary site inspection must be made and site approval <br /> p{ granted on all structures involving sanitary facilitice <br /> ?fore 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 /> 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 AND APPROVED. <br />