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Burnett County Office of Zoning Administrator C -0 o <br /> ApP��GATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H 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 O <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinan sand the laws and regulations of the State of Wisconsin. a <br /> ................................. .. ... .............1��h...4: ! ✓F,? ..C�O,...��? ' . y o <br /> Q <br /> N J <br /> O NER (please rirtt) TRACTOR or SURVEYOR or AGENT Q ;i <br /> � �.. ..&&k. . .. v..................... ri. ,� T......c . ;2 �.... . ................... <br /> A RESS ADDRESS <br /> ......................................................................................... <br /> ADDRESS ADDRESS <br /> PHONE . .......................................................................................... �Q :C <br /> PHONE <br /> ............. " <br /> PLUMBER WELL DRILLER <br /> ............ 0 <br /> ADDRESS ADDRESS <br /> h o <br /> .PHO . . .................................................................... <br /> _. < ®� <br /> NE ................................................................... . <br /> PHONE . ...................... o ,-« <br /> DESCRIPTION -�o o <br /> 4. Sanitary Facilities: o - Y <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details N; <br /> New Building ,,, Type of Construction: No. Bedrooms . ..... <br /> Addition Septic Tank Size Gals. ' <br /> Sanitary Size ...... ft. x .3.. f 4 <br /> Filling 4a. Absorption Field Site: ' <br /> 9 .......... Height............. Stories .f:.. .... . p r <br /> Moving .......... Area '7.a?-0 Soil Type .................................... <br /> ....... <br /> Grading Slope .......................................... o <br /> Mobile Home 3. Use (describe exactly, 1 family Perc. Rate ................................... 2, <br /> Privy „......•. hom garage, motel, c.) Dry Well r <br /> Well „•••,,, �. Seepage Trench <br /> ....... ..... .... . .. ..<"1 ..... .......... N <br /> Subdivision .................................................... Privy ......... <br /> Seepage Bed .......... <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 /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> 0 <br /> ...... ft. x�...... ft. .... ......... sq.ft. .,!I. 'lf........ ................. <br /> C,o(Co. Z7 ' CD <br /> N o. <br /> COKI.CKETf- ° <br /> S LA5 �I <br /> Ul 0 <br /> L1 S/ t Stops WELL <br /> QQ SLOPE -75' in <br /> o <br /> � zo' <br /> 01MOW R O ADCn <br /> CD C N G L W <br /> C <br /> -. CDC (D <br /> 2. <br /> 52q . 91�' N = Q � <br /> Ln <br /> 6 H C ' G ca � m <br /> Z o o' CD fD 70 <br /> o IVY 5. <br /> N•`�',o -i <br /> G y/ MM <br /> i / 0 C <br /> at of Owner or Age Date � ° C <br /> I X <br /> „ m <br /> jRe ks ............................................................... ......................................................................................................... CD C <br /> Co <br /> ........................................................................................................................................................................................ <br /> V <br /> U1 NJ <br /> Inspection Date ....................................... /c... o 0 0 o cn <br /> p J............. <br /> a31 .....:... ................ ..... ... <br /> Zoning Admin i trator � ' 0 0 0 0 0 <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitiu,, <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 /> iith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />