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Burnett County Office of Zoning Administrator o z <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 m c ® v <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> u S a <br /> ............. ...................... ..........y.................... ............. ..-... . ..�...... .�.�i. .......................................... H O <br /> 0 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> yt. <br /> ADDRESS ADDRESS + <br /> v <br /> ..........�.�N.... ?..4�..RY....No.t. ��P3a P� t S C- @.�..T:............!!�1..�........................... <br /> ......................... <br /> ADDRESS ADDRESS <br /> g�. .."..1..I..n. ......................................... ......................................................................................... <br /> PHONE PHONE <br /> s.l-A.. ..... ..................................... ......................................................................................... ,C <br /> PLUMBER WELL DRILLER <br /> ...................................... o <br /> ADDRESS ADDRESS <br /> 0 o <br /> C2 < <br /> ............ o' <br /> PHONE PHONE Z H <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> M <br /> 1. Work: 2. New Building Details No. Bathrooms .. ; o <br /> Building Type of Construction' No. Bedrooms ....2r... m <br /> Tank Size Gals.tic <br /> Addition .......... .................................................... Septic ...7.O.A. � <br /> Sanitary .......... Size ..3.9101 ft. x ft. ' <br /> .......... . . . . <br /> Filling 4a. Absorption Field Site: <br /> .......... Height............. Stories ........I..... i <br /> Moving Type Soil T e .................................... <br /> .......... Area ........................................... r— <br /> ID i <br /> Grading Slope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly 1 -family Perc. Rate ................................... <br /> Privy Dry Well 1 <br /> home,garage, motel, e <br /> � . <br /> Well Seepage Trench .......... <br /> Subdivision Privy <br /> v .......... :�,- <br /> .......... .................................................... <br /> Seepage Bed .......... {9 w <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road _ V <br /> >etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a <br /> >ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ------------------ ; <br /> 5. Lot Size:SW A Fig. A. 6. Location: <br /> ft. x .............. ft. — ............................... sq.ft. <br /> CD <br /> h <br /> N p <br /> O `ram <br /> c' <br /> y & <br /> CD <br /> CD <br /> o <br /> 0 <br /> ��� �' • <br /> Cnr -0CN <br /> z <br /> Ln <br /> bW < � m <br /> 0 0 0' fD m 70 <br /> S' 3 <br /> 1'4�P <br /> N o <br /> .. �Gf ......Gl . ... ....... .......... ...... ..'.�.:1... ..�y � p <br /> >ignature of <br /> Owner or Agent �i7 Date ° C <br /> 3emarks•�1,O1444,J...4..�`�!..�..�?�l. .. ......... ... .... �Z1............................. - 0 <br /> X <br /> CD <br /> .......... .. .......... ................� cfl . . . <br /> ........................................................................................................... .................... ................................. <br /> �c <br /> ns ection Date o 0 0 0 o cn m <br /> (T N � <br /> p �/ 000000m <br /> Zoning tlminis rator iC o 0 0 coo !/) <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> afore 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 /> ig 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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />