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Burnett CountyOffice of Zoning Administrator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and thelawsgyy�`regulations of the State of Wisconsin. tDa <br /> 9 /I 1✓ 3 O <br /> OWNER (please print) CONTRACTOR or SMRVEVOR or AGENT a0/"`� T r <br /> ...../..`f..q.Yl..&A ............. ....... ...............................I.... . <br /> ....... .......... a <br /> ADDRES''AA ADDRESS p1 <br /> "1,..7..8l ................................................� <br /> ADDRESS.r✓/ .......... . .......................................................................................... •� :(n <br /> ADDRESS �1 <br /> L� Q <br /> PH....N......... f.... ..-�43....`f.................................. .PHONE................................................................................ �� a <br /> ...(.JY�}�.� . .................................................................. ............................................................................................ :N <br /> PLUMBER WELL DRILLER q i iQ <br /> ........................................................................................... <br /> ADDRESS .A...... ....................... <br /> ...... <br /> ............................ <br /> ..................... <br /> � V7 m DDRESS...... <br /> 0 o :Z <br /> c <br /> . ....................................................................................... . .E.................................................................................. Z H <br /> PHONE PHON 'Y <br /> DESCRIPTION o c <br /> 4. Sanitary Facilities: t � o ° ' <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••••••••• n.i o <br /> New Building ...(-... Type o onstruc ' n: No. Bedrooms ...z�.... 3 <br /> Addition T , ,,. Septic Tank Size Gals. .......... c ;� <br /> Sanitary Size./..... <br /> Filling/Grading ries ............... 4a. Absorption Field Site: ~ V <br /> .......... Height............. Sto <br /> Pit i <br /> Moving .......... Area .�.�.t7.. Soil Type .................................... r <br /> I <br /> Mobile Home ,,, ,,,,,, Slope ..•... `� <br /> Privy .......... 3. Use (describe exact) 1 -family Perc. Rate ................................... i <br /> Xj <br /> Well ; home,garage, motel, Dry Well .......... r <br /> Subdivision Seepage Trench .......... LIN ; <br /> Camping Unit .......... .................................................... Privy <br /> .................................................... <br /> Se �(.Y..y . <br /> -------------------------------------------------- ---- W <br /> ------------- C <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- \ Cr <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < <br /> \ H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> --------------- ------_—_------------------------------------- O i <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... 3 <br /> e <br /> 0 <br /> N o <br /> O :o � <br /> W <br /> w <br /> s <br /> m <br /> �6 9� T� o Z <br /> )e C_ <br /> d <br /> m <br /> imp <br /> / n fA G A E <br /> O . <br /> fl1 c w <br /> m . <br /> oZ <br /> 1rj 0. 3 <br /> d'b J m <br /> .....:................................ / ... ... ........... a <br /> Signature of O ner or Agent Da e m 0 <br /> <<� X M <br /> Remarks1.A..�/... Y-:/...,r.-'^-' `— ............... ................................... ....................... ..... <br /> 'y `Zlf�fflf"?v u <br /> L r.i.1��.....;; �u.�.......... ...............................^ .............................................. — <br /> J... �� <br /> T <br /> Inspection Date ... ....../I...:...b..C:... ... ...............: ............. ...................................... i '°i G' G" 0 8 o U m <br /> Zoning ministrator . . 8 8 $ $ $ $ fmn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving Sanitary facilities <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 plumhing 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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />