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Burnett County Office of Zoning Administrator iv CD o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o O <br /> TO 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 e <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- O <br /> ^ O <br /> TYyar�✓ ...7.������,P...�`r..��sk �r.�rAl...�h!xl�.�c .....:5A '1... Q�.�cI, S................................................. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT C M <br /> a <br /> ...... �1'A?/.Ce....................... E A.... .....1 ..................... a <br /> ADDRESS ADDRESS m <br /> .............................................. ............................................................................................ <br /> ADDRESS ADD>ESS <br /> .......... <br /> ' ' .....3. .. .��:.Q. ..7.............................. <br /> PHONE PHONE <br /> .......IA.L.U..f/.111 .......8l�../K V 7f............................ CT.. .....?l..V..!� .... /1.S..f'EQ�k��rJ..................... <br /> PLUMBER WELL DRILLER <br /> ..1.��.�,1.?...�!.�,•....,art.1...�.,8r-,&.......................... ............................................................................................ <br /> ADDRESS ADDRESS co C) <br /> 0 o <br /> r+ �.6 E <br /> . .......`f ............................................... ............................................................................................ o <br /> PHONE PHONE Z <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> No. Bathrooms <br /> 1. Work: 2. New Building Details o T, <br /> New Building ... ... Type of Construction: No. Bedrooms ...... .... CD <br /> . <br /> =R,4 Septic Tank Size Gals. .... <br /> Addition .......:!tt!Z............................ ... <br /> Sanitary0.... ft. ......•••• <br /> Size ..... .. .....� ft.x ..... <br /> Filling Height...`. .... Stories .....�........ 4a. Absorption Field Site: <br /> Moving .......... Area ........... 'os..SvA--.... Soil Type .................................... <br /> Grading Slope .......................................... ° <br /> ......... <br /> Mobile Home .,......,. 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy •......... home,garage, motel, etc.) Dry Well .......... <br /> Well ✓, 's, JP� tl'a8 �✓ Seepage Trench <br /> . P..."4'wl.. .�... ..l....t <br /> SubdivisionjR(�/� � � CJ?rfERct Privy <br /> Seepage Bed <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road <br /> setback, side and back CL <br /> yard dimension and location and setback from all bodies of water. If property is located at a highway inter- fl- <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. o' <br /> -------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Locption: <br /> lQ�.... ft. x .�E�r +7.. ft. — .�^�o�7(�D............ sq.ft. ..... ....T /� E <br /> 7' <br /> :r <br /> M <br /> r <br /> 2� <br /> C1 n R!tC NZ <br /> M <br /> I D Y b e' o <br /> �oje CN #o�.D/'uti <br /> _i J 'A0� <br /> Lf 3 0' <br /> CD C C: d vDmCD <br /> Z <br /> Z <br /> V <br /> ...A.. .. ................... o p <br /> ...�g6ate <br /> ... ate <br /> Owner or ge — <br /> �9 X <br /> Remarks -tt w ` f4..........7................................................................................................................ <br /> CD <br /> CD <br /> ........................................................................................................ . ................. .......�................................... :�► <br /> f N-n <br /> Inspection Date ....................................... l -� .cC:l... .......... . 0 0 0 0 o cn m <br /> p Zoning A ministrator <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 />