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Burnett County Office of Zoning Administrator C CD 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 <br /> shown herein. The undersigned agrees that all work shall be done in accordance witty the requirements of the Burnett County Land Usesi <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> !..1.�.. t .:....(..�. rS ..U� <S2/I� L.l. �4%.!.�......��= Sl61 <br /> � O <br /> ... -.f?:.. ; .. ............................ y <br /> OWNER please print) CONTRACTOR or SURVEYOR or AGENT m c=o <br /> ' �? . ­-....l .hM. .ip.,•s./. 116i ....141�..:...i1�..°.......... L.1=.4 .t:s..... ...... fir '................... <br /> ADDRESS ADDRESS � a)� <br /> ............... \ <br /> ADD <br /> ESS ADDRESS <br /> ..................................... <br /> PHONE PHONE <br /> :64 <br /> PLUMBER WELL DRILLER <br /> ................................................................................I........ CD <br /> 0 <br /> ADDRESS ADDRESS n o <br /> =f < <br /> «.c.................................................................. PHON.E................................................................................. o• <br /> PHONE <br /> DESCRIPTION o rt r <br /> 4. Sanitary Facilities: o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> New Building �( Ty e of Construction: No. Bedrooms .......... -0 <br /> Addition pp L <br /> ......,•„ ...t'Rl�?•..... ••......• Septic Tank Size Gals. \\\ <br /> Sanitary ...,•,•,•• Size ..... ;... ft. �...... ft. ......... <br /> Filling Height....,5'�..... Stories ...I.......... 4a. Absorption Field Site: <br /> Moving .......... Area .........s3.y.`Y...? .1� :......... Soil Type .................................... <br /> r <br /> Grading Slope ...................................... ... ° <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench .......,,, i <br /> Subdivision Privy ......„•, h <br /> Seepage Bed <br /> -------------------------------------------------- ———————————— <br /> - C <br /> Location of ly C proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road 7r e <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 ^ < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ti <br /> --------------------------------------------------- o <br /> 5. Lot Size: Fig. A. 6. Location: �^ <br /> ft x ....... ft. — ..........l�����. q ft. �4,A�I...�'C /..•.<►'..1� <br /> wia9Ab .sa. 94 Fr PAn <br /> .....737.�F'...R.t.B.► ........ <br /> Cn <br /> CD <br /> �� CD <br /> N p <br /> _ O� <br /> o� N <br /> O <br /> J _ <br /> 1 Q O <br /> CD <br /> cnr7 cnooz <br /> cu <br /> v _ _ < <br /> N � Q< - Q � <br /> Ov—' vC G (Q m <br /> 114 rn C - 0 <br /> �ig�narA/of Or o .... ............Ql 1. 3........ o p <br /> 9 Date C <br /> Remarks ... . .4trerC!`...lf-P.... ..Ll ../ �?R..,,K L..✓f�!� ! ....L .. .....7�1� X <br /> vv C 0 <br /> CD <br /> to <br /> Routilh.S...A5....t�A..R.i.NAi.s� ...Chi+�M. �.. ..s �... c ...�.� ...!��' F �s r9�=fc� i R c U '�, . . . <br /> ............ <br /> Inspection Date Qiyrct4 � o 88 0 o N m <br /> ;1�� b000 m <br /> Zoning Ad ,nistrator�� 0 0 0 0 N <br /> JOTE: A preliminary site inspection must he made and site approval granted on all structures involving sanitary facilities <br /> lefore 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 /> /ith is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />