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Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 = <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '< — <br /> N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a �. <br /> a <br /> o <br /> a F <br /> ..........Gar.dan..G..... xan. ............................................ ........................... ....................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> ..... ....5322..Hanson..Gautt...U9................................... — o <br /> ADDRESS ADDRESS <br /> ..........Gry.stai.,...MT1.....55.42.9........................................ � :0 <br /> ............................................................................................ <br /> ADDRESS ADDRESS <br /> ............ .... . . ............................................................... ............................................................................................ <br /> PHONE PHONE <br /> ..........Donald..Daniels................................................ ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> :N <br /> ........ Box..bl..............Sir.en.,...WZ....5.4872.................. ............................................................................................ <br /> ADDRESSADDRESS............................................................................. J n O <br /> ..........7.7.5-.9.63..-2333..................................................... �. <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ...7...... o <br /> New Building No. Bedrooms <br /> o <br /> .......... Type of Construction: <br /> Septic Tank Size Gals. 10.Q0... <br /> Sanitary ...x.... Size .............. ft. x .............. ft. .......... i <br /> FillingfGrading .,....,... Height............. Stories ............... 4a. Absorption Field Site: \(n <br /> Moving .......... Area ............... ............... Soil Type .................................... \' <br /> ............ <br /> Mobile Home Slope ................................1 Y@.i : <br /> Perc. Rate ............................ ...... <br /> Privy .......... 3. Use (describe exactly, 1 -family � <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision ......,.., Seepage Trench .......... <br /> .................................................... p <br /> Camping Unit ... ...... Privy .......... ry <br /> . .................................................... Seepage Bed ..x..... F . <br /> :oo <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig A. Include road F 6) :in <br /> a <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- i � �, <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING p Q — a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. W O <br /> -------------------------------— —____--_------------- , W a iCi7 <br /> 5. Lot Size: Fig. A. 6. Location: r �j <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... G. o <br /> 0 <br /> eco+ rn <br /> J N <br /> e <br /> N < ° <br /> 3 <br /> See Attached <br /> 0 <br /> 0 <br /> E <br /> s <br /> a' <br /> m w <br /> z <br /> z <br /> 0 <br /> w <br /> a <br /> onm ' dmz <br /> � _ =- `FL <br /> k n _ <br /> 9. on . m m <br /> o o m m a m <br /> Z cc naM <br /> o am 3 <br /> vt - <br /> o ?Sam <br /> ,� o 70 <br /> � ......................... ..5.....'Z ..g ' <br /> Si nature of Owner or Agent ' Date X <br /> m <br /> Remarks ......................................................................................................................................................................... m m p <br /> °4 <br /> .. .......................................................................................................... ... ............ .... .. ............................................... : : : <br /> InspectionDate ....................................... .... .. .tel . . .... . ...................... o v, o 0 P u, m <br /> 10' Zoning Administrator 8 8 0 8 go <br /> cTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitioS <br /> -e construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> plication before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> a permit has been issued A permit may be revoked if misrepresentation of any of the information conveyed here <br /> - <br /> nd to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administratol . <br /> SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />