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Burnett County ; Office of Zoning Administrator W CD o 0 <br /> APPLICATION 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 < H o Q <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use � <br /> I CD <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 o. :^ <br /> . V <br /> W1` �l a K� L �drls h a F,f rj <br /> . . ....... ........ .............8........................................... ............................................................................................ cho <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a m <br /> All <br /> a <br /> ADDRESS ADDRESS y <br /> . u. -r.......WLAF....�..z.. ...... ................. ............................................................................................ <br /> ADDRESS ADDRESS <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER <br /> v <br /> ADDRESS ADDRESS CD <br /> o <br /> 0 < <br /> ............ o' <br /> PHONE PHONE Z • <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ......•••• o t <br /> New Building .......... Type of Construe ion: No. Bedrooms � J <br /> Addition Septic Tank Size Gals. .......... �. <br /> .......... <br /> ........0./S:.....-. .b. ,�............. f <br /> Sanitary ........•. Size ......f.. ft. x ..Zy...... ft. ^� <br /> 4a. Absorption Field Site: M ' <br /> Filling .......... Height... ........ Stories ....I......... f <br /> Moving .......... Area ........................................... <br /> Soil Type .................................... r i <br /> Grading Slope .......................................... �+ <br /> .......... <br /> Mobile Home Perc. Rate ................................... ' <br /> .......... 3. Use (describe exactly, 1 -family <br /> Privy .......... home,garage, mo e , e .) Dry Well <br /> Well Seepage Trench .......... <br /> !� _ <br /> Subdivision •.•.••„•• r Privy <br /> ..... ........ . . . : <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------- -- C/) <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 \' a <br /> 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 y <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O: o <br /> --------------------------- -------------------------------------- o: <br /> 5. Lot Size: Fig. A. 6. Location: // <br /> .!!.U..O.... ft. x ..l7���... ft. — ............................... s ft. ......Xcd .. F,.�.>�. �..c�I .... <br /> 0 <br /> 0 <br /> Lo <br /> .00 <br /> �. <br /> � Cn <br /> L1 <br /> CD <br /> / Y . 44 <br /> M to r- T Cn co Z <br /> CD m . d c m <br /> LD. Naa< = �-+ Q_ <br /> -0 rr < <br /> m <br /> Z o o fD <br /> o � a � <br /> cn <br /> (� o <br /> G 72 - � m <br /> v. .... ................. ........................... o C <br /> Signature of Owner or AW 444 T/ Date <br /> Remarks ...... ...rtu-�L... /�P/. ..� �J .�C... . x CDCD <br /> ........;................................ 4A TI C: <br /> 4, <br /> .� , CS, NJ n <br /> Inspection Date 'A. ........... . . o o ED CD <br /> . ..... . . . ....................... CD 0 0 0 o m <br /> ZoningAdmi istrator k-J <br /> :� o. 0000 CD <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> oefore 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 />