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Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < v, <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 /> Vanee, Sanita io Code, and with all other applicable County Ordin nces and the laws and regulations of the State of Wisconsin.J.i .n. ................... 3 0 <br /> OWNER (please print) CO RAQTOR r SURVEYOR or A EINNN a — <br /> (r��� �LpI I laa - <br /> AIE�V.. . .t.y.l..!C. .. .aa�..... .SS A ESS i <br /> Pen. .............................. ............................... <br /> t..,.. 1.. ..mil...... l.l ........................ ...l�wl��JP k r,....Lob. 5t1�13..................... <br /> ADDRESS ADDRESS <br /> ........................................................................................... ............................................................................................ NJ <br /> PHONE PHONE <br /> ................................................................................... ... <br /> .. ... ........ELL...DR....IL.L.. 'E'R....... <br /> ..... <br /> ....... <br /> ........ <br /> ....... <br /> ..................,.............,.. <br /> PLUMBER W <br /> ........................................................................................... . ... . .............................................................................. 0 <br /> ADDRESS ADD.. R..ES..S : <br /> ti o <br /> ........................................................................................... . . ...........................................,....................................... .Z N - <br /> PHONE PHONE <br /> °DESCRIPTION 4. Sanitary Facilities: o °r <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> New BuildingT No. Bedrooms .......... -Oo <br /> ype of Construction: 0 <br /> Addition .................................................... Septic Tank Size Gals. .......... <br /> .......... <br /> Sanitary $ize ft. x ft. .•.••••••. <br /> .......... .............. .............. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ..................... Soil .................................... <br /> 0 <br /> Mobile Home Slope <br /> .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Fare. Rate ................................... <br /> Well , home,garage, motel, etc.) Dry Well .......... <br /> SubdivisionSeepage Trench .......... <br /> Camping Unit .......... .................................................... Privy <br /> -t <br /> Seepage Bed .......... <br /> ------------------------ -------------------------------------------- On <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road Z <br /> Ce <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. I 5 <br /> --------------------------------------------------------------------- F <br /> 5. Lot Size: Fig..A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... -� <br /> n) <br /> X/ _N <br /> ( N O <br /> iyy O � <br /> �V yam. <br /> C <br /> s <br /> I <br /> W _ <br /> n T < c <br /> FE <br /> Z <br /> m <br /> o a =61 � <br /> � 3 <br /> ........... �a-)8-1.......... O <br /> . .. <br /> Signature of Owner or Agent Date '� p <br /> t��` � <br /> Remarks ......................................................................................................................................................................... a'C) M <br /> vi <br /> ........................................................................................................................................................................................ —Y : <br /> ......................................................................................................... ... .................. ... .. ... ................. ............. �r(`(`j'' . . : : : : <br /> Inspection Date ....................................... ...... ... .. .I..:... J'ti"... ... ......... u o N o m <br /> Zoning Administ or dYI i 8 8 8 8 8 8 co <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 Wild- <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 Adm inistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />