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Burnett County Office of Zoning Administrator D � o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3' o <br /> .311 <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as < m M ?0 <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 <br /> Ordinance, Sanitation Code, an wit�hh/all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. n <br /> ..I ........... ..a.. .....Z.. . ../..Cf...r ,.�... ................ ............................................................................................ 3 <br /> O <br /> OWNER (please print CONTRACTOR or SURVEYOR or AGENT a <br /> . . 'a....k( ....L.. .r�/� c� ............................................................................. <br /> m <br /> AD ESS ADDRESS <br /> gg�� n <br /> AD ESS ��//3ADDRESS <br /> T. ./ i ,.... .. ...... .. ......... ................ ................................................. ....................... <br /> PHONE PHONE �� <br /> M <br /> PLUMBER WELL DRILLER <br /> .......... <br /> ........................................................................................... .................................................................................. n o <br /> ADDRESS ADDRESS m 0 <br /> o <br /> ........................................................................................... ............................................................................................ z .: <br /> PHONE PHONE m <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building „X„ , Type of Construction: No. Bedrooms .......... <br /> ,,N►t Addition J� Septic Tank Size Gals. <br /> Sanitary .......... Size ..... ... t. x ... ..'.Q... ft. .......... <br /> 8 4a. Absorption Field Site: <br /> Filling)Grading ,,,,,,,,,, Height..���Stories ....-:....... � . <br /> Moving .......... Area Soil Type .................................... <br /> Mobile Home Slope .......................................... .+ <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Seepage Trench ”"""" <br /> ' <br /> Subdivision ......... l L 6 <br /> Camping Unit .......... SeePrivy .......... <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 Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- (`v o- <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> A <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. op o <br /> --- C <br /> 5. Lot Size: Fig. A. 6. Location: ` R <br /> C <br /> ...l�......... .. .. ft. — sq. ft. <br /> V ft. x .. �} ............................... ............................................................................... ,� w <br /> JJ � <br /> �37rci.�S�pMsl � a^ <br /> I-AtCo "° <br /> 0 <br /> 71 a0 <br /> �\ 0 <br /> 3 a <br /> L T <br /> C] Z <br /> 1- O <br /> Ilk. DO <br /> a <br /> Ipd m <br /> ion <br /> 7� N r 9 y of <br /> < m c m <br /> m soL: - y _4 <br /> 9 Lin <br /> m - <br /> z M <br /> oo� � � n 77 <br /> 0 <br /> r <br /> Sig ature of Owner or A t Date o C <br /> X <br /> „ <br /> Remarks ......................................................................................................................................................................... m� 0 <br /> . N . IT <br /> ... ...................................... <br /> Inspection Date ....................................... ....-. .... ° . ... ... . ................. <br /> ...... <br /> Zoninistrator <br /> 8 8 8 8 8 8 cn <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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />