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Burnett County Office of Zoning Administrator C o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 : <br /> 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as n O :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 /> Ordinapce, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. CD <br /> Q \\ \ 'O <br /> � .... ...`a.. N... �'+.T��. . C.... .......... ......................................................................................... y C7 <br /> C� <br /> G <br /> OWNER lease int) CONTRACTOR or SURVEYOR or AGENT r 3 <br /> Cb <br /> ADDRESS <br /> p ADDRESS h <br /> A�DREs..C�^s. jg�./?� �vN, <br /> ��QQ .. ........................................ ....................................... <br /> SS i `v <br /> ADDRESS <br /> PHONE P H..ONE................................................................ <br /> ....................... ,b <br /> PLUMBER .....RI............................................................................... <br /> :W <br /> WELL DLLER <br /> pADDRESS ............................................................................ 'G <br /> ADDRESS.. CD <br /> � O <br /> PHONE ............ o .+ <br /> PHONE z <br /> DESCRIPTION <br /> o W <br /> 4. Sanitary Facilities: o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms ` -0 ' <br /> .......... : <br /> New Building T No. Bedrooms <br /> y yp of Construction: m <br /> Addition •„••V,• ,ycf:' P LoW Septic Tank Size Gals.. ..................................... : <br /> .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... ' '• <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving ... Area ........................................... Soil Type .................................... ; <br /> r E <br /> Grading o <br /> .......... Slope .......................................... - �+ <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home, , e erl Dry Well <br /> Well .......... n.G. y(. .................V,tN �00� Seepage Trench <br /> Subdivision "• <br /> Privy .......... i <br /> .................................................... ; <br /> ----------------------------- Seepage Bed .......... <br /> ---------------------------------- <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 yard dimension and location and setback from all bodies of water. If property is located at a highway inter- _L <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. LE <br /> ---------------------------------- ----------------------------------- ° <br /> i. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. <br /> p :V 0 <br /> Uven /�O rU /airy GoT :M/, ct <br /> 0 <br /> z 0 <br /> o <br /> ��ch . f�x t S l-tq,� ff omit= <br /> Nj:VV <br /> N <br /> ru ` ADh r T c 1V <br /> N -n <br /> 22 <br /> CD <br /> o <br /> d <br /> CD <br /> /=iRF. <br /> 79'9 cnCD <br /> r �� o0 <br /> Z CD <br /> .� <br /> . . � <br /> . .... ................... �.... .. . p <br /> gnature of caner o A t aD to 'W o C <br /> (�amarks ....f`!.�7.. 1N.Cr 1 .�...Lf>.lafi�/7.....I���SS G?�.,c�....`'.p <br /> .f�qre....;................................................ � X - ? M <br /> m <br /> ..... . ............................. <br /> ..................................................................... ............................................................................ . . . . . . . <br /> ,Q <br /> spection Date ....................................... ��../...:... ... : 0 0 6 6 0 o m <br /> QQQ�� O: T1 <br /> Zonin Ad inistrator o 0 0 0 0 o cmn <br /> iTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> ore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> s application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> unt'r) a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> h 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 />