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Burnett County Office of Zoning Administrator C _ o O ` <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> O r� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H -h <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 cD <br /> 7.1.1 .... ................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> J <br /> ............. C <br /> ADDRESS ADDRESS <br /> ..... ?.� ... `�.3 ......................................................................................... <br /> ADDRESS"" . ADDRESS <br /> PHONE................................................................................ .PHONE <br /> ................................................................................ �'•,�, <br /> :..r 0 Fh c.a.................... TF 1O <br /> N ... ... <br /> PLUMBER . . :3 <br /> ........... ......... <br /> .......... ................................................................................. � iC <br /> ADDRESS ADDRESS o_ 0 <br /> :Uer + < : <br /> �l�1-... .. ?...]....................................... ........................................................... z y <br /> PHONE PHONE <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ! ° 0 ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> New Building .......... Type of Construction: No. Bedrooms S?�... <br /> Addition Septic Tank Size Gals. Z�.... rr� <br /> .................................................. <br /> Sanitary ..... Size .............. ft. x .............. ft. <br /> Filling ..•..,..., Height............. Stories ............... <br /> 4a. Absorption Field Site: <br /> Moving Area Soil Type .........5 � <br /> r <br /> r <br /> Grading Slope ................C.'....................... ° <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ..............or.,10.............. ( <br /> Privy home,garage, motel, etc.) Dry Well .......... �a <br /> Well Seepage Trench <br /> Subdivision .......... ......... l:A f�:L .... !.f:.0 .. ... Privy �3 <br /> Seepage Bed <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 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 N, �I < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :0 o <br /> ---------- <br /> ------------------------------------------------------- <br /> 5. Lot Size: IFig. A. 6. Location: <br /> x .3Q�p <br /> 4/.. ft. — ............................... sq. ft. ..'.... . .... .i4��iA'�. (� <br /> r, <br /> Q <br /> a <br /> to <br /> CD <br /> �N I 0 <br /> 0 <br /> 7 <br /> :` l\ T <br /> ------------------ <br /> CD <br /> m <br /> 7 <br /> CD <br /> m <br /> C/) d W G� <br /> _. CD <br /> m. NQQ< - r+ Q � <br /> oy. c : � L m <br /> Z o o `D CD 70 <br /> o <br /> cn <br /> �k0 <br /> ..... .. ...... ............ ..... ... ........ ...... - .73 s m <br /> Sign ure of Owner r Agent Date ° ` C <br /> X <br /> ,p'� . .. ........................................................................................................................ <br /> Remarks .... .................. ......... m m <br /> m 0 <br /> J................... .......... ........... u <br /> ............ .lox 'L�� <br /> ...................................... '`� v c <br /> Inspection Date .k..: ..� 1................ �7112L� �? 88 0 0 M rrl <br /> . ..... .. .. <br /> • ..9...... . . ... D. <br /> Zonin Administr for �J 0 0 0 0 0 Cn <br /> JOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> ,efore 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 /> ,ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> dith 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 />