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r <br /> 3urnett County Office of Zoning Administrator v - o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT h 3 <br /> o <br /> -O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c j <br /> )rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3. a V <br /> eA�-nlea�e <br /> 7 ° O'....................................... ...................... ..................................................................... j print) CONTRACTOR or SURVEYOR or AGENT a ?c` 'D <br /> Ss. � ..... ....................................... ............................................................................................ Q fir? <br /> \DDRESS ADDRESS <br /> CD <br /> ".�� :..? - .. .......................... <br /> ADDRESS ADDRESS <br /> l.-..G.�.a.. ��. . ..:.. .a. � G............................. ............................................................................................ <br /> 'HONE PHONE <br /> :s <br /> .................................................... .W...E........ <br /> D.RI.... .. ..................................................................... <br /> 'LUMBER LL LLER.... <br /> ............................................................................ <br /> 1DDRESS ............................................................................ <br /> ADDRESS 0 <br /> o h0. < <br /> 'HONE PHONE <br /> DESCRIPTION 0 <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details : o <br /> New Building ...✓ Type f Construction: No. Bedrooms L <br /> .......... <br /> Addition Septic Tank Size Gals. <br /> v `D <br /> ................... .. <br /> Sanitary .......... Size ..... ft. x ..o�..(...... ft. .......... <br /> Filling ...•...... Height............. Stories ............... <br /> 4a. Absorption Field Site: t <br /> Moving Area Soil Type .................................... fit: r <br /> ................................... ...... <br /> Grading o <br /> Slope .......................................... C <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> PrivyDry Well .......... ' <br /> .......,.. ho e,garage, motel, etc.) <br /> Well ...•...... Seepage Trench ...... ... �o <br /> ............I................. <br /> Subdivision Privy I <br /> .......... .......... ......................................... . . <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- Cn <br /> -ocation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road <br /> o- <br /> etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o <br /> ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING t < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ; 0 <br /> i. Lot Size: Fig. A. 6. Location: C <br /> ,.f? a..... ft. x l.��td.... ft. — ............................... sq. ft. ............................................................................ .. O <br /> O <br /> l� �- CD <br /> `� <br /> 0 <br /> - <br /> 0 <br /> .t y <br /> �r c: CD <br /> ?,. o <br /> c <br /> CD <br /> `C <br /> cn r -0 Cn Z <br /> �J? cDi � 0 <br /> N.4P- <br /> r'j Q Q,G — f-r _Q <br /> Z O p' CDto <br /> Lo <br /> :(1 O <br /> ID M <br /> signature of Owner or Agent G� Date � x 70 <br /> a7-J-3 o <br /> iemarks ......................................................................................................................................................................... <br /> CD <br /> ....................................................................................................................................................................................... <br /> ....................................................................................................... fn <br /> v'000 —' Nj <br /> nspection Date c- <br /> �JiyJ O o <br /> Zoning Administrator -c 0000000 <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> More construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />