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3urnzt-it�County Office of Zoning Administrator '*fS o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT A 3. o <br /> FO TU-Ir ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N — ;�J3 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use r <br /> Drdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a ;� <br /> y a O <br /> i m <br /> err�ra..1.s ........jo.........tA.y `.!V �."... ............................................................................................ <br /> DWNER (please print) CONTRACTOR or SURVEYOR or AGENT `�° <br /> �.T....... ....................................................... _. ............................... <br /> ........_ m <br /> . S- <br /> 4DDRESS _ ADDRESS _ '"�►--------�--- '- � <br /> ........... ?:f..9.0...... ............................................. <br /> 4DDRESS ADDRESS ;� y <br /> ..`r�-�'.... .. ........................................... ........... <br /> HO E PHONE <br /> 'LUMBER <br /> .......... <br /> WELL DRILLER ............................................ <br /> J: <br /> 4DDRESS ADDRESS ' m G) <br /> c o <br /> �./ <br /> ............................................... p o <br /> 41 <br /> SHONE PHO. .NE � <br /> (z r <br /> DESCRIPTION 4. Sanitary Facilities: `° 0 ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ......•••• o <br /> New Building ••...••. Type of Construction: No. Bedrooms CD <br /> ti <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... :F <br /> Sanitary .......... Size .............. ft. x .............. ft. ?" `C <br /> 4a. Absorption Field Site: 9: <br /> Filling ••.,.••.,• Height............. Stories ............... p � O <br /> Moving Soil Type .................................. <br /> .......... Area ........................................... <br /> Grading Slope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... �. <br /> Privy ........., home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench <br /> .......... .................................................... <br /> Subdivision .......... Privy .......... .L �[ <br /> Camping Unit Seepage Bed <br /> -------------------------------------------- -- <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING �. y•_� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. q p' <br /> r <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ........................................................................... G <br /> Application for land use (6 month period) <br /> MI, Cn <br /> Camping Permit from )G . 9 t) to Juno. le. , J()a 4CD <br /> (date) (aate)- <br /> N '_ <br /> Co <br /> o 7 <br /> 'Y <br /> o :a <br /> .>U 0 <br /> T y <br /> o <br /> o: + D <br /> (n 1— T (A co Z <br /> m C cj c ID <br /> � 6 -3 < — � <br /> LD. N a CLG - '+' a <br /> m <br /> o O j m ro <br /> cn � <br /> _ CD Y. m <br /> p <br /> Signature of Owner or Agent Date o :� C <br /> Remarks ......(�I, .....CC`?,+-,y? .1.........�.. .c�.�..,....nG s✓� .,cs.....;.. ,.. CJ -......4?-�.,�-... ..... <br /> T :� ? m <br /> CD <br /> ....�..... .. .. ................................................... <br /> o: o <br /> Inspection Date ....................................... 91� �. ... . . .. . :\ o <br /> T7 <br /> ax o o M m <br /> p Zoning Ad�-st-r-a- �� 0 0 0 0 N <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />