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Burnett County Office of Zoning Administrator v o Z <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 < H o ?Q <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use (D c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> O .e,�p�l...d...0.t�...!g........(,�.Yervu).6.4.. ............................................................................................ y C <br /> O E (please rant)P CONTRACTOR or SURVEYOR or AGENT a V CD <br /> ... ........... .:�.. ...... . ....s..re.................. . . ...... . ............................................................................... <br /> A JDESS ,✓ ADDRESS <br /> C..y. -.!�JU�.✓..Y.1........K./. ..........`�.. ..(....... ............................................................................................ �rJ <br /> ADDRESS ADDRESS <br /> 'HONE PHO E � <br /> .�.sr........ <br /> L..... .� .............................. <br /> Q <br /> SLUMBER WELL DRILLER • <br /> 4DDRESS ADDRESS ✓ S <br /> CD <br /> / 3^c( � <br /> SHONE PHONE 7 <br /> nP -' o <br /> DESCRIPTION <br /> 4. Sanitary Facilities: o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> o <br /> New Building .......... Type of Construction: No. Bedrooms .......... L <br /> CD <br /> Addition Septic Tank Size Gals. <br /> Sanitary Size .............. ft. x .............. ft. .......... <br /> Filling •••....... Height............. Stories ............... 4a. Absorption Field Site: (� <br /> MovingArea Soil Type ..................... .............. 'f r........ . ........................................... V'r• O <br /> GradingSlope .......................................... <br /> Mobile Home Perc. Rate ................................... i <br /> .......... 3. Use (describe exactly, 1 -family Dry Well <br /> Privy •••„••••. home,garage, motel, etc.) <br /> See <br /> Well ;, •, page Trench .t <br /> .................................................... <br /> Subdivision Privy .......... W <br /> .......... .................................................... <br /> Seepage Bed .......... c Z <br /> -- ——————————————————————————————————————————————————————— ————— C/) <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road 1 <br /> ;etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- R) a <br /> ;ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING C % < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> r O <br /> ------------------------------------- ------ o 7 <br /> 5. Lot Size: Fig. A. 6. Location: �-- <br /> ................................................... .. <br /> 3.3.t?...... ft. x ... �.Z?.. ft. — .�(�•. .O.�.Q...... sq.ft. ........................... � 6 <br /> i <br /> CD <br /> fn <br /> NQh <br /> r- 7 <br /> 7 <br /> 3 <br /> p Z <br /> CD <br /> II 7 <br /> 4— <br /> �p cnr � � cnooZ <br /> � v <br /> n v("j 6' 7 <' `° � = <br /> -6 O.1 < v 7' 0 <br /> y a � M <br /> OZ O <br /> m <br /> z p <br /> signature of Owner or ent Date — <br /> 3emarks ............................................................................................................................................................ .16 m <br /> C <br /> ....................................................................................................... ........................... n <br /> nspectionDate ....................................... 12 .. ........... ... . . �o': <br /> TI <br /> 00 oocN' M <br /> Zoning Ad inistratof� :I 0 0 6 0 o ccn <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 /> rg 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 />