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Burnett County Office of Zoning Administrator - 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <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 � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> N,9.,81— ,C..,,.51'l S TAD IFL F <br /> ......................................................... . A—G"i .................................. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT � � \ <br /> a r\ <br /> Et...........r............................................................................... ............................................................................................ <br /> ADDRESS ADDRESS <br /> ................. ............................................................................................ <br /> ADDRESS ADDRESS <br /> ........... <br /> ........................................................................................... ........NE......................................................................... :S <br /> PHONE PHO <br /> ........................................................................................... ............................................................................................ J� <br /> PLUMBER WELL DRILLER <br /> ........ ............. . . . . . ................... <br /> . .......... <br /> A.DDR .......... .................................................... .A. .D...D.R ........ ........ .... .............. ...... ................. ... <br /> C) <br /> n p <br /> ............ <br /> .PHO-H-O-N..E................................................................................... O .: <br /> PHONE Z N <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••••••••• o <br /> New Building .......... Type of Construction: No. Bedrooms .......... i a <br /> Addition ,,,,?X,•, ,4( ,,,•,•••• Septic Tank Size Gals. .......... <br /> Q. ..0.. .. ..................../.. <br /> Sanitary .......... Size ......./:Z. ft. x .........c.4 ft. .......... <br /> Filling/Grading .......... Height,$-. -r Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area ..................... Soil Type ............................... <br /> .................... r i <br /> Mobile Home .......... Slope .......................................... o <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision ......••.. Seepage Trench .......... <br /> ................................... ................ - . <br /> Camping Unit ...I...... Privy .......... <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 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- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING W `- <br /> U « <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --------------------------------------------------------------------- <br /> 5. Lot Size: _ Fig. A. 6. Location: <br /> ............................................................................... <br /> ................ ft. x .............. ft. - ;�O..r.'y.0��.5... sq. ft. : <br /> Q n <br /> N o' <br /> i 4--,v7' <br /> •PT rC i'FpAr A J C' <br /> 70'� %V f <br /> ',r t 17E cy z ZDO <br /> :O <br /> a !O <br /> e` <br /> M w r no y 2 <br /> n Q yf < c m o F <br /> - n <br /> on < <br /> Z oii' m DnRt <br /> o <br /> � _m <br /> n <br /> Ta a a1 <br /> NN 0 <br /> ✓�Zrr .. p <br /> u' /y ............ ...................................... C <br /> Signature of Owner or QAgent �(�" / Dlaytep - <br /> Remarks ........�..2Lr....Gbaie+cA�?L{.`� ............'1 .. ..%�.7..f.❑... 7-.6 -�'�X#/l...... ........... <br /> / o <br /> ......... ... ...................... gym, E p <br /> ........................................................................................................................................................................................ .\ <br /> ........................................................................................................ .. <br /> .. ... ............,...... <br /> . ... . <br /> ... . . ...... . .... <br /> OIeo:: <br /> In <br /> Inspection Date ....................................... ......f .. ............ <br /> Zoning Adminis ator "':, <br /> 8 8 8 8 8 8 U) <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 />