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Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT � Vj <br /> m » <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described land <br /> located <br /> /�pas shown herein. The undersigned agrees that all work shall be done in accordance with the requirements ofl.the m vl <br /> 9" .. ..... .... ........ . ........... ......................................... ................... ..L.F.......Y........................................and 3 3 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable Count Ordinances and the laws <br /> re ulati nsoftheStateofWisconsin, l a <br /> M T S – <br /> OWNER lDlaau print) CONTRACTOR or SURVEYOR or AGENT 7�_ <br /> ..................... ........... <br /> ADDRESS ADDRESS l� <br /> / 7 - <br /> 4.� .s u,!Z......?j a aa . . . . . .......................................................................... <br /> ADDRESS � ADDRESS i <br /> ...�.a5� ....................... . . . . ............................................................................Vii...... ^^� <br /> PHONE PHONE I $lNi <br /> ............................ .. <br /> . ............................................................ WEE"L..L...D.RIL.. L... ..ER...............................................................IL...... <br /> PLUMBER I El cJ <br /> ........................................................................................... ADDRESS ��....... •o E <br /> -' 3— <br /> ADDRESS i io Ll <br /> c <br /> ........................................................................................... .P..H..ON.. E........................... <br /> ... <br /> ........................... .............. <br /> .......�....... O :V ' <br /> PHONE <br /> Z <br /> o <br /> 1. Work: g No. Bathrooms <br /> 1 0 <br /> DESCRIPTION X e u nst to n: 4 NonlBedroometies: { o <br /> Sanitary <br /> 2. New Building Details <br /> New Building ... T Cq j1+ .. ....... <br /> Addition ,,,,,•Lt/.t� .... m ........... Septic Tank Sae Gals. ..�....... E i <br /> Sanitary Size .......3� ft. x ... ft: 4a. Absorption Field Site:Fillingl . <br /> Moving <br /> .......... Height../J.. Stones .... ..'. . Soil Type............. ............... <br /> Moving .......... Area ........�....... . . . T.. ....... r <br /> Mobile Home .......... ••'•'•• <br /> Privy .,,,,.,,,, 3. Use (describe exactly,9 -family Perc. Rate ...........................IL...... 0 <br /> Well ..,,,,,.,, home,garage,motel, etc.) Dry Well z <br /> Subdivision .......... T' 4. Seepage Trench ..�....... <br /> P.......�F... .�............... <br /> Camping Unit ....... ......�� Privy <br /> Seepage Bed <br /> __________________________________________________________________ to <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in FiA. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is locat d at :J ' <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. Z <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. _ o <br /> ______________________________________ ................... . ... T '.O <br /> 5. Lot Size: Fig. A. 6. Location: -• w ? pn <br /> ............................... <br /> . --------- ... . <br /> ................ ft. x .............. ft. — sq.f'. ... ........ ill <br /> o o <br /> i0'0 <br /> ag' (a' <br /> I � <br /> x - 0 <br /> P <br /> !�tP77 l�q Mp d <br /> i i i e <br /> III <br /> I I <br /> Nv (tlr Dco Co <br /> M c . m m 00 c c <br /> m n — m m � n <br /> C 0 Z O N •G O <br /> I O FAO D <br /> n ; y <br /> O C m <br /> o C <br /> �— / — S% a <br /> x n : m <br /> Signature of Owner or Agent Date li n C <br /> Remarks 'I u, <br /> m •• <br /> a <br /> ......................................................................................................... ........ .................. ... ... .. ............... ..... $ 8 <br /> ` r..... N W N T <br /> Inspection Date ....................................... ........... .. ..... . ... .�......1.`. /U. ...... . u, u, o . N m <br /> Zoning Administraa�-Y'l 888 8 f/f <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has bee, issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or Specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />