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Burnett County Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N ' <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> �� -- /I �; a � O <br /> ..........�l.alt] r.........C.Q�-.h............................ h.o�az........................................................... y ,tCD <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a ID.. .. n�...63 ....... .hfi,�,. 1...... .cx�. .......................... <br /> .................................................................. . <br /> ADDRESS ADDRESS /— <br /> ........................................................................................... ............................................................................ <br /> ADDRESS <br /> PHONE PHONE <br /> .............. 1.an ................................................................. ............no.h. ................................................................... <br /> PLUMBER WELL DRILLER <br /> :O......... ........ ...................... ...................................................................................... <br /> ...... ............... ........ —. <br /> ADDRESS AD.....DRESS n o <br /> PHONE PHONE z N r F" <br /> DESCRIPTION 4. Sanitary Facilities: o ° <br /> 1. Work: 2. New Building Details No. Bathrooms not* o <br /> New Building ....X... Type of Construction: No. Bedrooms ....-_.... ti <br /> Addition ,,,,,,..... �lond............................ Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ...A.0... ft. x ....1.(Q.... ft. •"......• J <br /> Filling .......... Height.../.O.Tf Stories .....I......... 4a. Absorption Field Site: i <br /> Moving a�.� Soil Type .................................... <br /> .......... Area ......... ...�:�1,.+,r........ o <br /> Grading Slope .......................................... } <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... i <br /> Privy ho e,garag , mo el, etc.) Dry Well .......... <br /> rr� Seepage Trench r <br /> Well .......... D.QIGI ..... .Q(.LS•P.... <br /> Subdivision .......... Cby}.. .Y�S.�Lq.Q.....C.el .�'71f. Seepage Bed J <br /> ---------------------------------------------------------------------- cn <br /> Location of proposed structures and existing structures,well,sewage systems, roads, etc.,should be sketched in Fig. A. Include road C: <br /> Vv s <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- CL <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. �� N <br /> ---- — ----- ----------------- 1 <br /> o� <br /> 5. Lot Size: Fig. A. 6. Location:, �,1 ^y i <br /> a! 1}...... ft. x ./.._51o... #. — ............................... sq.ft. 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M.'Ar.....ls......ap.....4a17y w1l.I. n <br /> b� srr / <br /> a :r�n o00o cNiim <br /> Inspection Date ....................................... m <br /> Zoning Administrator o 0 0 0 0 fA <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 />