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Burnett County Office of Zoning Administrator C _ o . <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD c N <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. C �,� <br /> a � 1 <br /> / y <br /> a. r..... ,P).v-....+ ..�..!4........................ _ r <br /> OWNER ( ease print CONTRACTOR or SURVEYOR or AGENT aco <br /> o....ys..........s. ..n. . .... ��0..�.:...... ............................................................................................ <br /> ADDRESS ^ Y ADDRESS CL <br /> CL <br /> � ��► <br /> N:.wa..............� hTi �.� .P. !F0..'........ ¢�............................................................................ <br /> ADDRESS ADDRESS <br /> �s W <br /> PHON PHONE ' <br /> . .... ... ~'`yJ�...................................... <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS <br /> n o <br /> CD <br /> ........... o r+ <br /> PHONE PHONE <br /> z y r <br /> DESCRIPTION 4. Sanitary Facilities: / ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••••••• �New Building No. Bedrooms � o <br /> ..•....... Type of Const*ucttt'w�: IL , 0 <br /> !S /I�e <br /> Addition Septic Tank Size Gals. .......... I <br /> .......... .......�-X................... ......... .. <br /> Sanitary x..... Size .............. ft. x ..... ...... ft. <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: / <br /> MovingArea Soil Type ........ Q. ...Q r <br /> o <br /> Grading .......... Slope .......................................... �« <br /> Mobile Home .......... 3. Use (describe exact) famil Perc. Rate ................................... <br /> Privy .......... home,garage,motel,etc.) Dry Well <br /> Well ••.......• Seepage Trench .......... " <br /> .................................................... iv <br /> Subdivision ........., Pr y <br /> .................................................... <br /> Seepage Bed <br /> ---------------------------------------------------------------------- L N u <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road c n <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ?7 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING C' <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. y <br /> ao-------------------------------------------------------------------——— <br /> 5. Lot Size: [/ Fig. A. 6. Location: <br /> ................ ft. x ft. — 7 Q�/'!r.�sq.ft. ; <br /> .y..s'...v.......................................... <br /> CD <br /> IN)0 <br /> zy- <br /> ` T <br /> oz <br /> ZCD <br /> CD <br /> 0 <br /> 4 <br /> �o cn co z <br /> CD c d ZJID = <br /> C CD <br /> N. NQa<0y G m <br /> Z o o CD CD <br /> o <br /> Q o � <br /> M <br /> ............................... F..� .::.. ' .. o p <br /> Signa ure t Date r+ — <br /> V X <br /> Remarks m co 0 <br /> .�v- -.............................................................................................................. <br /> �,� <br /> CD <br /> ........G 4�e_IL :'...................................................................................................................................... _ <br /> ...............................4............................................................................... ................. ... .. ........................................... <br /> K3 110; 000ED8L rm <br /> TI <br /> Inspection Date ....................................... l.. ... .............. : o 0 0 0 0 0 <br /> oning A@j inistrator 0 0 0 0 0 0 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />