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�-1/7 L . <br /> J <br /> Burr:4tt County Office of Zoning Administrator 0) CD o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT v' 3. :3 N. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as wi Q <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m 1,4 <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 Q T't7d M. 4s......M I .......C.46*7-:� ..... ........ ......... .. ............. <br /> 0 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT CCD fD <br /> x y H+ <br /> .. ....................................................................... (..R ...........I .l...t........................................ <br /> o.. �(` <br /> ADDRESS ADDRESS <br /> CO <br /> . ..C..7" ./�................................................... .........`4�.0 0../V d! .'�.. 5.. a. <br /> ADDRESS ADDRESS <br /> j �v <br /> 'b <br /> PHONE PHONE <br /> . i 4..........SC. 1�J !C' ................. ............................................................................................ ` J <br /> PLUMBER WELL DRILLER <br /> .. 9l..cr................. .... '. <br /> ADDRESS ADDRESS ( m L� <br /> :..... ... ..>... .................................... ......................................................................................... <br /> PHONE PHONE z H <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms . o ►J <br /> 'k <br /> New Building c+ Type of Construction: No. Bedrooms <br /> Addition ...... .. ...... <br /> Septic Tank Size Gals. U.0-0 <br /> Sanitary l ..... Size .............. ft. x .............. ft. <br /> Filling .......... Height.......�.... Stories ............... 4a. Absorption Field Site: h <br /> Moving Area Soil Type ..............1./`f4..,P..... c r <br /> ........... . : <br /> Grading Slope .........c ►. .Ct.......... .......... 3 <br /> • o <br /> .......... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ....................... ........... f <br /> Privy .......... home,garage, motel,etc.) Dry Well .......... <br /> Well Seepage Trench .......... 1-11 76 <br /> ................................................... <br /> Subdivision Privy .......... h ' ' <br /> .................................................... <br /> Seepage Bed .......... wr <br /> ———————————————————————————————————————————————————————————————— -- .tr <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road )i N C <br /> Aj all <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- s <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. a y <br /> w N j. <br /> 5. Lot Size: f Fig. A. 6. Location: <br /> ... ft. x . f�......... ft. — ............................... sq.ft. ............................................................................... i ^ A <br /> i <br /> { � n <br /> o' <br /> tt ww, V_ <br /> Vr N <br /> J � <br /> o <br /> 7T xc�Fb :_n <br /> CC <br /> CD <br /> M cnr -U: oZ <br /> � 0) � dCD <br /> CD <br /> •o cn <•C <br /> m 'C <br /> bNN � m <br /> Z o o'`D fD 70 <br /> o <br /> 01 <br /> /C.42.. ................. ...... ...... C <br /> m <br /> i4.'V <br /> Signature of Awner or Agent Date W <br /> „ "Remarks .......................................................................2 ......... <br /> m <br /> �» <br /> .......................................................................................................... ........................... ................................................ .� _, N <br /> Inspection Date ....................................... AAa o 0 0 0 o cn m <br /> p .... . ..9...... . .. ...... . ...................... :.1 . 000000m <br /> Zonin Ad inistrator�u o 0 0 0 0 o cn <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 />