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Bbrnett County_ Office of Zoning Administrator Z' 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT � 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ti..l.. ..1. ...............:T.Q.1.I�.L'.........I............. ................ ....................................................... H _ <br /> OWNER (please pri t) / CONTRACTOR or SURVEYOR or AGENT O <br /> ��C.. .. ................................................................................. ' <br /> ............ ................................. <br /> E�S�$/ y�., �!a 1/ Q ADDRESS .� <br /> ADDRESS. ..I..!✓.. ./...C.!..I..�.I.Y..(il..... .D.1 ADDRESS............................................................................ \ •`` <br /> PHON... /F!.............. ............/...................................... .PHONE................................................................................ <br /> PLUMBER WELL DRILLER <br /> p .(-4 <br /> ........................................................................................... ............................................................................................ _. <br /> ADDRESS ADDRESS � � L <br /> n :� <br /> � • 6 <br /> ........................................................................................... ............................................................................................ o' <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: y ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .. ... T;,0 o <br /> New Building y Type of C ons rat No. Bedrooms ..OZ...• i� i <br /> ..lt... pp M <br /> Addition ,,, /i /Yj :........ .............. Septic Tank Size Gals. .......... �O <br /> .......... ... .. G . . <br /> Sanitary .......... Size .aZ.... .�. ft. x .. ft. """•••' <br /> FillinglGrading .......... Height.. . . ..//.. tones .l............ <br /> 4a. Absorption Field Site: ^' <br /> ta. �: :� r i <br /> Moving .......... Area ...... .. ........... ............. Soil Type .................................... <br /> Mobile Home Slope ' <br /> Privy .......... 3. Use (describe exactly, 1 -f milt' Perc. Rate ................................... :S <br /> Well home,garage, motel, t .) Dry Well t p <br /> Subdivision 7/� Seepage Trench .......... <br /> .......... .ff4ii <br /> Camping Unit .......... Privy .......... <br /> .................................................. . Seepage Bed U <br /> ------------------------------------- --------- f <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. include road c <br /> O a :IT <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 I / <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> ---------------------------------------------------------------------- <br /> 5. Lot iz Fig. A. 6. Lo do <br /> g, /n� �n r1� ,I' p i t7 <br /> ...I li... ft. x . .4:.Q.. ft. . .....y C�.a.'.Q.... sq. ft. c...I.L U.IN.Q.O�.... .Q:.�l..�.�:5...LU.I............ 1E�, p� <br /> :^I � A <br /> Zary P4�i7k B1(,. skV o <br /> � o <br /> � aW1 <br /> O l <br /> 0 <br /> F1 <br /> yl � <br /> I � <br /> a <br /> : h <br /> Z <br /> 6 <br /> 1g <br /> (v Zoo � no � <br /> d . n m <br /> Fz-r1� <br /> o m <br /> Signature of in r4 r Agent Date <br /> Remarks X M <br /> .F.......... . T : v <br /> .... ... .................................................................................................................................................. N <br /> ......................... < c1 .....t1-�G I d, <br /> ,ry q . ....................... <br /> s . <br /> Inspection Date AmtZoning nrator <br /> a:I° <br /> O <br /> 8 8 8 8 <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 We made without approval of the Zoning Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />