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J. <br /> Burnett County Office of Zoning Administrator v -- <br /> 0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT rt 3 , \. <br /> v <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as :o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3cD <br /> a <br /> .r= . F1..1'.. .N... ..13R.��.......................... <br /> OWNER (please print) CONTRACTE.. OR.o..r..... ..... ...R. ...A..G <br /> . . .... .................. .... N , o <br /> . <br /> SURVEY....O or ENT..( a CD <br /> .......... <br /> Q <br /> 40DRESS ADDRESS <br /> m <br /> .......................................................................................... .......... <br /> 4DDRESS ADDRESS <br /> -. .. -. 'a. <br /> 'HONE PHONE <br /> ...D.RI............................................................................... :W <br /> 'LUMBER WELL LLER <br /> ................................................ . ..DRESS..... ................................................................................. <br /> p <br /> 4DDRESS AD... <br /> 0 O <br /> <D <br /> ........................................................................ ......................................................................................... p' <br /> . ................ . . <br /> 'HONE PHONE Z `+ <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> T <br /> New Building .., Type of Construction: <br /> No. Bedrooms �° <br /> Addition „•• ,¢M, Septic Tank Size Gals. 1' <br /> .......... ... .. : . <br /> Sanitary .......... Size ..aZ..`"V... ft.x ....... ft. .......... ? <br /> Filling .......... Height.�..`....... Stories ..../......... 4a. Absorption Field Site: — <br /> Moving Area Qls O .�. k................. Soil Type .................................... r— c <br /> .......... ..... ... . . <br /> Grading Slope .......................................... o <br /> ........ . . : <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... ; <br /> Privy home,garage,motel,etc.) Dry Well ; <br /> Well Seepage Trench .......... <br /> ......... ?? .F-........................... <br /> Subdivision Privy .......... i <br /> .................................................... Seepage Bed <br /> Ui <br /> ---------------------------------------------------------------------- <br /> -ocation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road <br /> s <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 /> ^ Q <br /> ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING (� < <br /> iTRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> -------------------------------------------------------------------- <br /> i. Lot Size: Fig. A. 6. Location: t, <br /> A-6.4r...... ft. x ft. — ..,1� �i�Zf 5....... sq.ft. � <br /> m <br /> v 0 <br /> N <br /> O j <br /> cQ <br /> H <br /> 0 <br /> �Ly' v 70 <br /> c� <br /> z <br /> �\ M <br /> CD <br /> CD <br /> 7s <br /> m, NaQ< <br /> a to< C : '� �' 'O <br /> oNH : m <br /> Z o O fD <br /> o <br /> p <br /> �o <br /> ........................ <br /> ......... is <br /> signature of Own r Agent Date ' C <br /> X <br /> iemarks .................................... m ; c c m <br /> .................................................................................................................................... <br /> CD <br /> ...................................................................................................................................................................................... <br /> .................................................................................................... ..................................................... :\ <br /> CD Date ....................................... c 0 0 6 6 6 m <br /> l:L+i2.e0 <br /> Zoning Adm istrator <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> :fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> is 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 />