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Burnett County Office of Zoning Administrator C _ o 0 <br /> ,APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. o <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as :Op <br /> shownOierein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD c p0 <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a ^` <br /> O <br /> ?�.. .. . �.k......................... ...................��'....6.../.. . ............................................ y <br /> � - <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a CD <br /> ; <br /> .................................................. ........................................................................... o :� <br /> . ................. : . <br /> ADDRESS ADDRESS r+ <br /> `° <br /> O ' <br /> :L- <br /> GJed .. ............................................ ............................................................................................ <br /> ADDRESS ADDRESS <br /> ............................................................................. ............................................................................... <br /> PHONE PHONE <br /> a �.�� ........ .../r,. .s........................ ............................................................................................ , <br /> w <br /> PLUMBER l .� WELL DRILLER <br /> ............................................. ............................................................................................ C) "o <br /> ADDRESS ADDRESS 04 44 <br /> m L� <br /> ...........4F6.6..y/.d.7..................................................... 0 <br /> c < <br /> 0 0 :h <br /> PHONEPHONE....................................... ....................................... 0 0 0 <br /> Z r— C <br /> DESCRIPTION 4. SanitaryFacilities: o :n <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New BuildingType of Co....X.. n ru�L'on: No. Bedrooms .... J <br /> �t <br /> Addition .......... GUOOd Cr .'5: Septic Tank Size Gals. .......... �+ <br /> Sanitary ....X... Size ....r.�,�r..t. ft. x ...��.... ft. <br /> 4a. Absorption Field Site: <br /> Filling Height. ..... Stone ........... V <br /> Moving .......... Area .....A?—Al� Soil Type .................................... 0: <br /> o <br /> p <br /> Grading �' <br /> Sloe .......................................... h <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy J... home,garage,motel etc.) Dry Well .......... \ <br /> Well /\ / Seepage Trench .......... <br /> �..!�....I..... . . .. .. ............ . <br /> Subdivision .......... .................. . Privy g <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 \I 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- e� 0- <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. <br /> —————————————————————————————————————— Q o <br /> 5. Lot Size: Fig. A. 6. Location: :4 <br /> ................ ft. x .............. ft. — ............................... sq.ft. <br /> � Q.�� Zvi�.j in8 ' ,4•� �� �. ........................................................ .................. <br /> 3, CD <br /> 9 <br /> 0 <br /> o <br /> I � � <br /> :A-- <br /> z ` <br /> La <br /> CD <br /> �o Cn -0 U)oo Z <br /> m c 2. m v c m <br /> m �Fj a0a< — 3—rt' 0- <br /> OH;� < cc m <br /> Z oo m 70 <br /> 0 0 <br /> D p <br /> � .................. <br /> � <br /> SignatureeofwnerorrAgentRemarks . .. ..... ................................................................................................................................................... m c <br /> Co <br /> r/9....................................................................................................................................................................... u <br /> .Arm ,:Z.�J............................ ............... o <br /> Inspection Date ..Z....'��-�-�...... ... ......... ... . ... . .. d o 0 0 T <br /> Zoning Admi istrator�� o 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before 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 />