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Burnett County Office of Zoning Administrator" o z <br /> y APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT B. <br /> TO THE ZONING ADMINISTRgTOR: The undersigned hereby makes application for a Permit for the work described and located as 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 m c <br /> Ordinance, Sanitation <br /> Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> � ...... �! �! .. ............................ ......... ..........CE..... ......................... o <br /> OWNER (please print) ` CONTRACTOR or SURVEYOR or AGENT a :N, CD <br /> k1 . .Z. . �1..-....`�zl.. `>... R Gu: ........... ... <br /> AD Q _ <br /> ADDRESS DESS <br /> d <br /> ........................................................................................... '.......................................................................................... <br /> ADDRESS <br /> ADDRESS <br /> ........................................................................................... 4 <br /> PHONE PHONE i x <br /> F,, t <br /> PLUMBER WELL DRILLER 4 :�� <br /> ..... .3.D.. .............. ............................................................................. 1 <br /> ADDRESS ADDRESS <br /> -y�l:..... n.. i....... .................Z........................................................................................... ` <br /> PHONE PHONE z o + 1 <br /> DESCRIPTION r N <br /> 4. Sanitary Facilities: ( ° 0 ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> v 'V <br /> New BuildingNo. Bedrooms ... .. <br /> ...�... Type of Construction: <br /> Septic Tank Size Gals. '7YV S' <br /> Addition .......... .............� 11....�f.�.�/.rJ,�... ... :� < <br /> Sanitary .... . Size ... :.. ft. x ...B.Z!... ft. � <br /> Filling g 4a. Absorption Field Site: :w <br /> .... .. Hei ht....... ... Storieess ..... ....... <br /> Moving Area ...............� G a• Soil Type ..................h ... <br /> .............. <br /> Grading .......... Slope ....................... L�..... Vim_:. ° <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ....................... ..... <br /> Privy „......•. home, arage, motel, etc.) Dry Well ......... <br /> C�,¢•3 <br /> Well ti Seepage Trench .......... :V <br /> �(... /../ ............... <br /> Subdivision Privy <br /> .................................................... <br /> Seepage Bed W X <br /> -------------------- ... ... <br /> -------------------------------------------------- _' tx cn <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- a <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: L1 Fig. A. 6. Location: 26 <br /> �q <br /> � ...... ft. x ..9.9Q.. ft. — ...3..Tf .. sq.ft. ...............` `aE! .4.Q .. ........ ................ <br /> Cl) <br /> o <br /> N <br /> +vim O <br /> ^'L`�/,e <br /> �Vv ✓ / <br /> :0 <br /> CD <br /> Cn <br /> CD <br /> CD CD <br /> _D �QQG 3 <br /> N _ <br /> Q1 <. <br /> z CD <br /> `D CD <br /> o <br /> M <br /> o <br /> :.....FiVo� .... .. ..... .... .-.. .�:.: 3 ' m <br /> Signaf Owner or Agent Date p <br /> � o <br /> X 70 <br /> Remarks ......................................................................................................................................................................... „ m <br /> M <br /> t m <br /> Inspection Date Qrn-� J N...................................... �' 00000v, m <br /> ZoningAdmi istrator 0 0 0 0 0 0 Cn <br /> VOTE: 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 /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> vith 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 />