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Burnett County Office of Zoning Administrator a o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 �\ <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and Iodated as m -^ <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 Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin_ 3 a i ik�) <br /> C Y J Lt"a S �0 <br /> ........ ........ ......... .. . ........................... .. ............. ......................................................... T"'............................. _ <br /> OWNER (please print) � CONTRACTOR or SU RVEVOR or AGENT <br /> -t ( Cj <br /> .....'7 <br /> ?-S. ............. �........C:............................ ....................................... 1 a <br /> .............. A <br /> ADDRESS _^ ADDRESS ..................................... .... .......... <br /> Co .5r 67 ')"e /L) ,j 1 <br /> ....... ........... .. ................................�......................... .................................................................................{.......... <br /> ADDRESS ADDRESS :j [ <br /> lr�� - vS9 - 33y <br /> PHONE PHONE <br /> ........................................................................................... . .WELL. .....DR...I..LLER.L'E' .......................................................... .......... <br /> PLUMBER � <br /> ADDRESS ADDRESS ' <br /> n o <br /> PHONE PHONE <br /> DESCRIPTION <br /> 4. Sanitary Facilities: ° o ° <br /> v <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building Type of Co ruction: <br /> No. Bedrooms .......... M <br /> Addition Y „• ,{;t...................................... Septic Tank Size Gals. ..........t <br /> ..........Sanitary .......... Size .....d2 ftx ? ftRillingtGrading ,,,,,,,,,, Height..... ..... Stories .. ......... 4a. Absorption Field Site: <br /> Moving .......... Area ..U.�.Sr. ,.d.�. !s�.�rr},r?C� Soil Type ............ .......... i .o <br /> Mobile Home ire!`F Slope ............................... .......... : .. <br /> Perc. Rate ........................ .......... <br /> Priv : <br /> v 3. Use (describe exactly, 1 -family Well <br /> Well .......•.. home,garage, motel, etc.) Dry • • <br /> Subdivision Seepage Trench .......... - <br /> —_Camping Unit .......... Privy I......... . <br /> 93 <br /> ------------- -------- -------- Seepage Bed--------- ..-- <br /> Nm <br /> Location of proposed structures and existing structures, well,sewage systems, roads, etc., should be sketched in Fiy. A. Include road <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of wafer. If property is located at a hlghw y inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. - <br /> ___ <br /> o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ...�b.L.... ft. x ft. — ............................... sq.ft. ......................................................... .................... <br /> I >- <br /> 0 o' <br /> o � <br /> eL� <br /> �xb _ _ <br /> E <br /> o <br /> N <br /> v <br /> --' —--- --TT <br /> 1' .I <br /> Dec K— 9P/ <br /> cn r v m z <br /> st <br /> f _ - F <br /> > m <br /> a <br /> -_ e— <br /> --- 1 <br /> . �.... ..../��/. . ..... .....::............ ....... ..../. .. .. ..... `o C <br /> Signature of Owner or Agent Date <br /> X 71 <br /> Remarks .................................................... .................... . ..................................................................................... ....... <br /> � : m <br /> �G <br /> i' ;,rn .� 1. o <br /> `. <br /> ........................... . ..... . . L „............................. .... <br /> ........,.... . ...!!lW '' ..... ..........:. o m <br /> Inspection Date ................. <br /> /ll m <br /> �1 <br /> Zoning dministr I !& $ 0 0 o N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures ivolving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolationtest must he attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any pl robing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if mi srepresentatlon of any of the information conveyed here <br /> with is found to exist. Changes in plains or specifications shall not he made Without approval of the Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE HAND APPROVED. <br />