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Burnett County Office of Zoning Administratoru 0 0 <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 C>\ <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 --%Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> M <br /> . . n. ....M. ... ..h .. ............................... . ........................................... ..................... ........... ............ <br /> OWNER ( iease print) CONTRACTOR or SURVEYOR or AGENT a A <br /> :...N�.:............. ..... . .......................................................................................... a <br /> ADDRESS ADDRESS <br /> s.o:....st:........a. ..� ...M-A/... a . ...... <br /> ADDRESS ................................................ ........................................... <br /> - o <br /> ......................................................................... ................. �O <br /> PHONE ............................................................................................ <br /> PHONE <br /> .-.Y.. ..Y...�.. ..' -:3Z`6-11 <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... p <br /> ADDRESS . .......................................................................................... <br /> ADDRESS <br /> o <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: e, ° o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building No. Bedrooms 3 : o <br /> .......... Type of Construction: .......... i a <br /> Addition ...�/,.... ................,................................... Septic Tank Size Gals. .......... y ; <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... t^ <br /> Filling/Grading ,•.,•,,,,• Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type .................................... 'k <br /> .......... ........................................... : r- <br /> Mobile HomeSlope .......................................... I o <br /> .......... o <br /> Privy ......•... 3. Use (describe exactly, 1 -family Pere. Rate ................................... r <br /> Well ,,.,.••„• home,garage, motel, etc.) Dr Well .......... a <br /> Dry <br /> Subdivision ,,,,,,•,,, Sr-foQ in �Xl sal a Seepage Trench .......... <br /> ...................... . <br /> Camping Unit ......-„• 0.• q �•Sz Privy <br /> .(Jem ........ . ........�.c�.......�a..l(.U .......... <br /> Seepage Bed <br /> ---------- ----------- ------------ w <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road 1A <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. w <br /> 5 <br /> ---------------------------------------------------------------------- <br /> I y i <br /> 5. Lot Size: Fig. A. 6. Location: <br /> a :dp <br /> ...I.N..M.... ft. x .../.�e..7... ft. — ............................... sq.ft. ............................................................................... is <br /> N <br /> m <br /> N p <br /> 0 7 <br /> I UA <br /> 0 <br /> I � <br /> 0 <br /> © v � <br /> 3L> <br /> O <br /> Oo•vn I <br /> 0^ 5 J,� Cine :C <br /> SG/pP C <br /> YN <br /> o] Z <br /> IQ <br /> O 0 G <br /> 7 w ,� n C <br /> m <br /> •� ao : nm 70 <br /> -• • • -............................. . �F.�..�. .. .....!5.ba. = <br /> u `b z <br /> m <br /> Signature o�ner or Agent ate <br /> o C <br /> X <br /> Remarks2elf, .z$.`.. m m <br /> :m <br /> ......................................................................................................... ...... ........ ..... <br /> 'II <br /> Inspection Date ....................................... .. ........... ...... .. .... . . ... 1� u tg 0 � <br /> ................... <br /> Zoning ministrator <br /> O rr mm <br /> i $ $ $ $ $ $ y <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 tie made without approval of the Zoning Administrator. <br /> f1 SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> 1 l <br />