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Burnett County Office of Zoning Administrator _W CD o 0 <br /> APPLICATQN FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as O� <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 ael Ole <br /> o- <br /> �, 0 <br /> ..................................... ......... .............. ............... <br /> OW{NERd(pl/�ease print CONTRACTOR or SURVEYpR or AGENT Q CD <br /> 07 <br /> .............................................. ADDRESS........... ......................................................... o :� <br /> ADDRESS o> <br /> 2 , <br /> :� <br /> ADDRESS C c ADDRESS •sue <br /> 7 Aa� <br /> PHONE PHONE .. :. <br /> .1 <br /> e L <br /> �C' . ....�.... ...... .. .... s .............................. f L..L........Ge./..1.........c���r./...... <br /> PLUM R WELL DRILLER <br /> h <br /> .................... .................................... ...................................................... �. <br /> ADDRESS C <br /> /� fD� ADDRESS ��� ��J CD M <br /> — \ <br /> PHONE........ PHONE.­­­­.............. ........... ....................................... o >; <br /> DESCRIPTION 4. SanitaryFacilities' ° 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .......... 7 <br /> New Building .......... Type of Const cti n: No. Bedrooms , ... <br /> o <br /> CD <br /> Addition ,,,,,,,,,, / M e.• Septic Tank Size Gals. 1.... <br /> Sanitarya rt <br /> ...� Size .....�s�.. ft. x .....���.... ft. .......... <br /> Filling Height../..�C Stories ..oN... 4a. Absorption Field Site: <br /> sn�cQ <br /> Moving Area 70................... Soil Type ............................0..... <br /> rt o <br /> Grading .......... Slope ......................... 0......... :c �* <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate .................................. <br /> Privy home,garage, motel, etc.). Dry Well <br /> Well Seepage Trench rS..... <br /> Subdivision �1 Privy / t <br /> ................�?4.... '�.%................. � J.......... <br /> —————————————————————————————————————————————————— Seepage Bed-- a�A.bap .......... <br /> ------ :� N <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road ' C <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. � o• <br /> 5. Lot Size: Li A S' '00 Fig. A. 6. Location: . 3b>�r!Y` <br /> . 20 <br /> .... ft. x .13........ ft. — ...7—nt ................... sq.ft. / d <br /> OQ,oS e '✓,fit trn�a CD <br /> 5 re 70 � o <br /> =c : <br /> k-1 <br /> f <br /> z <br /> y o <br /> CD <br /> aP0 f <br /> V <br /> >, rn r- -v cn co z <br /> c�i fn o' � < f D c m <br /> CD <br /> z oo' CD m <br /> o <br /> U1 <br /> 0 <br /> '70 <br /> C m <br /> ig ature of Owner or t p <br /> Date C <br /> X <br /> emarks .............. T i ? m <br /> m 0 <br /> ........................................................................................................................................................................................ to <br /> ........................................................................................................ <br /> Inspection Date ....................................... ................ p: o o cn rm <br /> Zoning Admin' ator :`�� 0 0 0 <br /> TOTE: 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 /> 6th 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 />