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Burnett. County Office of Zoning Administrator d 0 0 <br /> ik <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3, <br /> TO THE ZONING ADMINISTR4TOR The undersigned hereby makes application for a Permit for the work described and located as < N c,`w <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m m :-I <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a :� <br /> _ _ — <br /> rN. .P ........ <br /> K L.... F�..r.......................... ............................................................................................ n <br /> 0 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m m <br /> ........).on..:.. .�. N...M. ?o`^L.. ..... .............. ................................................................I............ a N <br /> ADDRESS p p f'1_r 'Ac- . c y Ns Ni S-.S , �-�� ADDRESS :-`111 <br /> J2 <br /> ADDRESS ADDRESS 'Q <br /> ........................................................................................... . ....................................................................... .. <br /> . ................ �� <br /> PHONE PHONE <br /> ..WE....L...L DR......IL......LE...R.................................................................... <br /> PLUMBER <br /> O <br /> ........................................................................................... . .......................................................................................... o <br /> ADDRESS ADDRESS 0 <br /> I o. < {� <br /> PHONE PHONE Z 0 i ( <br /> DESCRIPTION 4. SanitaryFacilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building ,,,,.,,,,, Type of Ceps ruction: q ,f No. Bedrooms ...r.�..... ai m ',(1 <br /> Addition d Septic Tank Size Gals. .......... 4, < . <br /> ........................................y. ... <br /> Sanitary „!-- Size ....5...... ft. x ....ill.... ft. J; in ' <br /> 4a. Absorption Field Site: <br /> Filling/Grading .......... Height... .. Stories ............... :•'� <br /> Fl <br /> Moving .. .T.. ...... ............... SOII Type .................................... r <br /> .......... Area ... C: o <br /> Mobile Home _ . Slope .......................................... :� <br /> .......... <br /> Privy .......... 3. Use (describe exact) 1 -farm Pere. Rate ................................... NAP <br /> Dry Well <br /> ..L_.,f- garage, motel, etc.) """"" <br /> Well home, I <br /> g g Seepage Trench .......... i <br /> Subdivision .......... <br /> .................................................... Privy <br /> Camping Unit ....I..... ............................................... ..[ N <br /> Seepage Bed f �!Y..../ <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- o- ' <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING < <br /> :-1 p <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 5. t Size: U�/ v Fig. A. 6. Location: `J. <br /> ;iV 0... ft. x Z.L....... ft. — ............................... sq. ft. y v i <br /> .............................................................................. <br /> /y^V� � m <br /> N o' <br /> o z � <br /> 3 <br /> C <br /> O <br /> it <br /> o <br /> C, m <br /> I, } 0 <br /> is' � bpi <br /> I L C 'T/ / {V M VI e- -o F In oa Z <br /> llY C m m c m <br /> N d a m <br /> "O u V1 < : : C M <br /> m -. m <br /> z o0 n 70 <br /> o n ¢m 3 <br /> —7 <br /> )a o 70 <br /> � ... .: � ............ S <br /> ET C <br /> Signature of Owner or Agent Date - <br /> C G6. - �JGx f C .�G2Q_ C'...'.".!:.�..�.�.// .'. ........ <br /> G �-�'!7`.':K . <br /> Remarks ....�� ..... ............(.... ... ._-rL/....Cl......... ... ........... p <br /> X <br /> �� �tc <�z.,ti ............... = <br /> m <br /> � n <br /> I� q s <br /> o, X17` m <br /> Inspection Date <br /> �� Zoning Admini rotor � g 8 8 V> <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 he 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 />