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CCl <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 <br /> �1 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e <br /> Ordinance, Sanitation Code,an with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- U' ` <br /> a 1 <br /> yYI..�f� r — m 'R/ <br /> y <br /> '�) r <br /> OWNE' asE� t CONTRACTOR or SURVEYOR or AGENT a <br /> I.7. �......J.y..11. �t a +� <br /> . ... ............. ... ................ . ... . . . .............................................................................. m <br /> ADDRESS i ` ADDRESS <br /> ..........................................�........ ...."'E'S".............................................................................. — 7 —� <br /> ADDRESS AD.. DRESS <br /> PHONE/,l ................................................................ PHONE . ..... .... . <br /> Y/fEf' ` <br /> ......................... . . . ................................ .. <br /> Z.......... <br /> ............ ............ WELL DRILLER `V Vl\ � <br /> PLUMBER Y <br /> ....... .... .4 .. <br /> ................................................................. — h <br /> ........................................................................................... r. <br /> ADDRESS ADDRESS <br /> ........................................................................................... . .......................................................................................... N <br /> 0 <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° "f <br /> """ <br /> th <br /> Barooms ' <br /> 1. Work: 2. New Building Details No. o i <br /> New Building .......... Type of Co ru ion: No. Bedrooms a <br /> m <br /> Addition ;��( ,,... Septic Tank Size Gals. <br /> .......... <br /> ............... <br /> Sanitary .. ... Size .............. ft. x .............. ft. <br /> Filling t Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Soil Type i r <br /> Moving .......... Area ........................................... SoYp .................................... o <br /> MobileHome Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... 1{ : .t '• <br /> Well .......... home,gars e, motel, etc.) Dry Well O �i <br /> Subdivision <br /> Seepage Trench <br /> ���""'�� (� v <br /> Camping Unit Privy .... .. <br /> .......... <br /> .................................................. . Seepage Bed 1.�P <br /> Location of proposed structures and existing structures well, sewage systems, roads,etc., should be sketched in Fig A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter e- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING (� a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 1 <br /> ____________________________________________ O <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft — ..Y..d..`.... w.J..... sq. ft. ............................................................................... <br /> Z ' pro <br /> n <br /> q�: <br /> ud '�� <br /> so <br /> • -F! <br /> Q O <br /> Z <br /> o <br /> e <br /> n r u m Z <br /> c:,� d tp <br /> m <br /> Z O o D a m <br /> �m <br /> ,� .............. .................... o <br /> Signatu o caner gent Date ' <br /> X . . . . : . <br /> Remarks .................... ................................................................................................................................. ; . . . . . . <br /> an <br /> ............. ........................ ,...................................................................................................................... <br /> �/y......................... ........... II <br /> -L��Fd:ztl..L/ �lC� <br /> Inspection Date .... .. �` P 5 m <br /> /,/ N N O + N <br /> .I.......................... ... ......'....(......�.�ni in........ .......... ...................... �: U (li O fT U m <br /> Zoning or :I a g 8 8 8 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary faciilllitles <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 Ifo made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />