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Burnett County Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 0 3 0 Uj <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and F <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulations of the State of Wisconsin. _ <br /> •�t.m. ..a..s................�J.:;ax ./ ................. ...................................................................................... ..... _ <br /> o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT '� <br /> 3. .. .. .,...���.!..�cUt�.� C=........ .... ..................................................................................... ...... d 7— <br /> ADDRESS ADDRESS l <br /> .� cy6........ _ <br /> DORESS (� ADDRESS <br /> ..... ./....�d/ ./•••.................................................. . ......................................................................... ...... <br /> PHONE <br /> PHONE <br /> ........................................................................................... . .......L...D. ..RILLER.. ...... .............................................................. ...... <br /> PLUMBER WL <br /> n <br /> v <br /> ....................................................................... . ................................................................................... ...... _. <br /> ADDRESS - ADDRESS n O <br /> ................. <br /> ... . . .................................................................... . .......................................... <br /> ........................................ ....... O .� <br /> PHONE - •• • • PHONE C <br /> DESCRIPTION 4. Sanitary Facilities: ` <br /> No. Bathrooms .••• <br /> 1. Work: 2. New Building Details o <br /> New BuildingType of tructio� No. Bedrooms .. ....... <br /> Addition ••••...... ,,,,,,,,,. / Septic Tank Size Gals. .... <br /> . ... <br /> tt�� <br /> Sanitary Size ..... ..... ft. x ..S..r....... ft. <br /> Filling/Grading .......... Height............. Stories ............... <br /> 4a. Absorption Field Site: <br /> SoilType ............................ ....... r <br /> Moving .......... Area ........................................... o <br /> Mobile Home Slope .................................. ....... <br /> Privy ...7.`... 3. Use (describe exactly,'I -family Perc. Rate ........................... ....... m <br /> n <br /> Dry Well .. ....... <br /> Wen .......... home,garage, motel, etc.) Z � <br /> ���F Seepage Trench ..... o <br /> Subdivision .......... ?g. .�,t........................ Privy ..... <br /> 1 <br /> ..........{(��'� (r1 <br /> Camping Unit ......... 1t..11 . ........ <br /> .. ..... .. ... . .. ..................... Seepage Bed <br /> -------------------------------------- — �� c <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. g <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at _� - <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :� <br /> __ t y <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ..................................................................... ......... --ti <br /> N u� � <br /> :1 3 <br /> :c <br /> 0 <br /> � o <br /> Ri V <br /> 300 F�d�" yJ 9� ° <br /> N <br /> OSp``C, <br /> o d 0 ,11 <br /> m a 5 ic <br /> c m ic <br /> o to Z — <br /> z o m •2 D 1 <br /> o y'' to n : 70 <br /> o c m <br /> v ; o : 0 <br /> � � C <br /> o <br /> 3 <br /> 120".... x o <br /> A ' <br /> jReirnt <br /> reofOwnDatearks ................................................................................................................................................................. ....... m <br /> w � <br /> ............................................................................................................................................................. ............ .... o o <br /> ......................................................................................................... .. ... ... ................................... <br /> a . g <br /> o . . <br /> N N N rn <br /> �. tit N O O N m <br /> Inspection Date ....................................... ... . . .!?V....Zo'n'. .. m <br /> Zonin Admmi ator $ 8 8 8 W <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary,acilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this ap lication 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 b n issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans r 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 />