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Burnett County Office of Zoning Administrator M' o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ;' 3 �. <br /> .; cTO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H -* <br /> shown 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 Wisconsin. 3 0- <br /> I '+ Q <br /> ..RA.!'..�i.gAJ........ �.�,.r.!.+?... .. .................................................. y ' <br /> O <br /> ................... M <br /> OWNER (please print) � CONTRACTOR or SURVEYOR or AGENT Q <br /> CL <br /> A DRESS ADDRESS � ; <br /> ' . <br /> JCV.V.-?.r....LT.��? .....:.....5 +tin h.........5. .7 5.............. / ................. a......... <br /> ADDRESS ADDRESS i :r <br /> PH E PHONE <br /> ....... <br /> . ............................................................. .................................................................. :W <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS '� m � '•�,T,,, <br /> ........................................................................................... ............................................................................................ 0 0 W <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 ° <br /> 1. Work: 2. New Building Details No. Bathrooms •••••••••• � � o `C <br /> New Building . Ty of Construction: No. Bedrooms a— CD <br /> .... <br /> Addition r 9 vv.-� Septic Tank Size Gals. �« <br /> �....a < <br /> ..... 7 ... <br /> Sanitary ,,, •., Size ..Q.0...... ft. x .............. ft. .J <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ................................... <br /> Soil Type <br /> Grading Slope .......................................... <br /> .......... r <br /> Mobile Home .......... 3. Use (describe exact) �, I;f amily Perc. Rate ................................... <br /> Dr Well <br /> Privy .......... home,garage, motel, y ......•••• F. ; V <br /> Well �V Seepage Trench .......... � <br /> .......... <br /> Subdivision Privy ,� <br /> .......... , <br /> .................................................... . . <br /> Seepage Bed <br /> -------------------------------------------------- -------t .--- <br /> ---- _ Cn CA <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road a rTj <br /> KA <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- •T) 0 <br /> section, 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. y <br /> 0 <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> i <br /> ..�.3i.1�.... ft. x ..1S..L ft. — ............................... sq.ft. .................:................................. •� <br /> Cn <br /> :Oqk CD <br /> V/ 0 <br /> 0 O <br /> o <br /> n` `a a <br /> ;o sZs <br /> 0 r <br /> 0 <br /> 'h � <br /> .�� 0 <br /> CD <br /> C/) Cn op Z <br /> c m <br /> Oy.C : : •G ca <br /> Z O O fD <br /> 0 3 — <br /> � <br /> !� o <br /> o � <br /> � / 'W <br /> ... .. .......... ............f /.l.,1.8� :�` m <br /> r7 <br /> Signature4o0w;�ner jor Agent Date <br /> o C <br /> Remarks . ................ .. ................. ............................................ '' ' vm <br /> ....................................... <br /> C <br /> ......... CD <br /> 2 .................../ .4.` 1 ,� ...0 .�� ......... <br /> ........................................................................................... .................. ... ............ <br /> ......................... . <br /> o: csi T <br /> Inspection <br /> 9 00000c�'nm <br /> p l� l.3(`� .......... Q!1'"AQ <br /> 000oo6m <br /> Zonin Ad inistfat�r 000000 fn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with 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 />