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Wrnett County Office of Zoning Administrator W CD o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ;7+' <br /> o <br /> -0 THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < <br /> nown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD c <br /> )rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0 • <br /> Cam.. H <br /> )WNER (please print) ' ` _ CONTRACTOR or SURVEYOR or AGENT a <br /> l..:'..,3.6...�.N�'.... I ........................................................................... Q <br /> ADDRR ..�....1 .. ............ESS ADDRESS <br /> .......................................................................................... ............................................................................ <br /> ADDRESS ADDRESS C <br /> � 'l <br /> l��Z �q—��_�t� .............................................. <br /> ................................................................... <br /> 'HONE PHONE <br /> ................................................ ............................................................................................ <br /> 'LUMBER WELL DRILLER <br /> ADDRESS ADDRESS m G <br /> 0 o <br /> o' ` Di'HONE PHONE z N r- <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° o <br /> I. Work: No. Bathrooms .......... v Wj � <br /> 2. New Building Details <br /> New Building .......... Type of Const6luction: No. Bedrooms � t� <br /> p(nMt D / Septic Tank Size Gals. <br /> Addition P................�k° !�!...,,..}}........... ...... � c: <br /> Sanitary Size ..... L/.K. ft. x ......T. ft. .......... <br /> Filling g 4a. Absorption Field Site: <br /> .......... Height....(.�..... Stories ............... <br /> Movin Soil Type .................................... r <br /> g .......... Area ........................................... •� o <br /> Grading .......... Slope .......................................... r. <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy home,gara e, motel, etc.) Dry Well <br /> Well � Seepage Trench .......... <br /> Subdivision Privy <br /> .......... `�- <br /> Seepage Bed .......... <br /> -—— ——————————————————————————————— - <br /> Cn <br /> _ocation of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road e <br /> a- <br /> ;etback, 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 STRU TUBES AND ADDITIONS. i o. <br /> -------------- <br /> i. Lot Size: � 3 J Fig. A. 6. Location* d r 3 .�QGfiO/! "Z7 �0 rq , <br /> ft. x .............. ft. — ......�/............. , . . . ... .........�.. !IYLTIgLI� <br /> �'�0 sq.ft. � �ion..>� .:..... u1��h�%a�$ ,clD�t , R <br /> QFR,v�r '7o w/) DF Lt10ob ����� C'OK�ty <br /> E '5u N E7T" j cS*I' d F UUBSC. <br /> IN <br /> Qz o <br /> La <br /> V N <br /> I •e"F o <br /> CD <br /> O h <br /> C M 17- <br /> CD <br /> 0 6 Z) <. c <br /> -0 O H; <br /> o <br /> � ................. .... . ................... ...................................... <br /> ,o c <br /> Signature of Owner or Agent ate <br /> X 70 <br /> T <br /> Remarks ............................................... .............. ....................................................................................................... CD <br /> - <br /> Co <br /> ................................................................... ............................................................................... .................................... <br /> C ' <br /> .............. . ........ . :.................................... <br /> e» <br /> TI <br /> c: o00 ocNiiIM <br /> InspectionDate ....................................... 9.................... .. o 0 0 0 o m <br /> Zonin Administra ir o o o c 0 o cn <br /> DOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> iefore 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 /> vith 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 />