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I Burnett County _ - Office of Zoning Administrator D o 0 <br /> J APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The underpinned hereby makes application for a Permit far the work described and locmat as co <br /> shown herein. The undersigned] agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use �- C <br /> Ordinance, Sanitation Cod'e/,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 po <br /> rc <br /> i (A/ItK2�/V . ._�`.'..,..: n.(.fa.E -. ..7�.... l;�....... ON$T.. a � r <br /> OWNER (please Print) NTRACTO or$URVEVOR or AGENT <br /> ... ... ....... ... . . <br /> Il <br /> go ( lAftKu.Ew22gAcG 5...(_R ......... ✓c.S.'..................._ a ` <br /> ..............................I........... AA <br /> ADDRESS ADDRESSoi�PCW 11,41-ii mCv. <br /> ,..........._............... .. . . . . .................................................................... ............ <br /> J c <br /> y <br /> ADDRESS '. ADDR E$$ <br /> i <br /> .......................................:............ .............................I........ ............................................................................................ <br /> PHONE PHONEN\. : <br /> NES..........Ko. <br /> ........................ ..........6_Eco. .............. ...........:.......... ....... <br /> PLUMBER WELL DRI LLER <br /> W._.c3 ....._..... ........_._. ................. ........:. ...1 e. �. _ .................................._.......... z <br /> ADDRESS _ - ADDRESS m <br /> ...... ID E.-.. .. .. ..............:...... ............................ ............................................................................................ 0 � I <br /> PHONE PHONE Z N m <br /> DESCRIPTION 4. Sanitary Facilities: " o � o pe'. <br /> 1. Work: 2. New Building Details No. Bathrooms ......(.. o <br /> New Building ....�.... Type of Co s[rucbon: No. Bedrooms ._.. !� <br /> Addition ..._..J-P..... __........ Septic Tank Size Gals. 7. <br /> Sanitary .... ... Size .... ft. x S ..D ft. <br /> . ... <br /> Filling .......... Height........... Storiesies ................ 4a. Absorption Field Site: <br /> Moving .......... Area ..........L.I..ata.....I.............. Soil Type .................................... <br /> Grading .......... ��,� Slope ............................ ._.......... .. <br /> Mobile Home ......_— 3. Use (describe e o ctiblil Pere. Rate............ ...................... tT0 <br /> °U <br /> Privy homemDry Welt,garage, <br /> crucial,etc.) """ <br /> Seepage Trench ' <br /> Well ..:�:.... 1.............................................._... Privy .......... <br /> Subdivision .......... <br /> .................................................... Seepage Bed .......... <br /> ------------------------------------------------------ <br /> Location of Proposed structures and existing sVucNms,well,sewage systems,roads,etc.,should be sketthttl in Fig. A. Include read <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- c <br /> section, show the intersecting highways and the setbacks requirN along them and at the Intersection. CLEAR LV LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES,AND ADDITIONS. .lee) o <br /> ------------------------------------------ In <br /> 5. Lot She: Fig. A. <br /> .....�.......... ft.x .............. ft. — ......... s9.ft. \ Main1 <br /> �J <br /> N doGcs I <br /> :r a! <br /> » I v. <br /> L7 ^ t< <br /> ztell : . <br /> v <br /> q �d <br /> n elan. <br /> o , <br /> 0 <br /> B ' : t 1 <br /> ill o <br /> 1 ........._ -aa <br /> Signature of Owner or 'g nt Date <br /> es <br /> x : 'a <br /> Remarks ......................................................................................................... .................. <br /> .....................................................................:.............. ......:._......._....... .....................................................:................. <br /> ... 0jn <br /> .........................•............:................................... ...........................//...,........{.�.....`.. ....... ................................. oto 0 <br /> Inspection Date ....................................... <br /> 000 <br /> Zoning Administrator <br /> NOTE: A preliminary site inspection most be made and site aporoval granted on all suuctdles Involvingsanitary facilit <br /> before construction can begin_ In the case of sewerage disposal systems, a copy of the percol,llion rest'must bedtlached <br /> this application before a permit will be Issued. Do not purrhese or installer septic link, (to any plumbingrr start any buil <br /> o <br /> inn until a permit has baen issued. A permit may be revoked it misrepresentation of uny of the information conveyed her <br /> with is found to exist. Changes in plans or.sp er,ifications shall not he made without approval of the Zoning Adminisbatc <br /> SEWER SYSTEM SHALL NOT RECOVERED UNTIL INSPECTED RV THIS OFFICE AND APPROVED: JI <br />