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f <br /> Burnett County Office of Zoning Administrator T o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT W 3. 1 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < i; o � <br /> 0 d <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ' <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> FNi�...�...... � .L� d o <br /> ............. <br /> OWNEq (please print) CONTR ACTOR or SURV E YO Ror AGENT <br /> ......B...0..1.1....... <br /> .C�.t .......... ... ... ....... .. ............................................................................................ aqJ � <br /> ADDRESS ADDRESS <br /> :C <br /> l;?.f31�Aou/.. ........1!1/t... f............ ;O <br /> ADDRESS ADDRESS „AJ <br /> ...................5.`fg��.0 ............................................................................................ [ <br /> PHONE PHONE <br /> ��n <br /> PLUMBER....Y..... ...W.......... ..` ...C.l.................... .WELL DRILLE.R................................................................... iCP� 9 <br /> O........................................................................................... . .......................................................................................... m \��. <br /> ADDRESS ADDRESS <br /> n p <br /> ........................................................................................... < <br /> PHONEPHON.E....................................... ....................................... ?' _ <br /> DESCRIPTION 4. SanitaryFacilities: P o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms -o <br /> New building Type of Construction: No. Bedrooms .......... <br /> Addition Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .. . . f .. ....L ft. .......... i <br /> Fillin (Gradin 4a. Absorption Field Site: <br /> 9 g ......I... Height......`.C3. ries ....... ....... p <br /> Moving .......... Area ..J'..F�. . .. Soil Type .................................... . m <br /> . .. .................. <br /> y o <br /> Mobile Home .......... Slope .......................................... <br /> Privy ,,,,,,,,,. 3. Use (describe exactly, 1 -family Perc. Rate ................................... O '• <br /> Well .........• home,garage, motel, etc.) Dry Well .......... iiJ i <br /> Subdivision ,,,,,,,,,, i .-4;'� Seepage Trench .......... <br /> ........... I <br /> Camping Unit .......... Privy ....... .. <br /> ... ... .. .L......... ........... ........ <br /> �y, Seepagee Bed .......... <br /> -------------------------- � �_'"�-- ---- �- ----------------- <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- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING i < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o .� <br /> ------------------------q---------------------------------------------- c <br /> 5. Lot Size: .�% �G Zea Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — . . . sq. ft. 10"V... ..../ .. . ......•..: ........'........... <br /> n <br /> N aO <br /> O � <br /> Z <br /> 0 <br /> o <br /> J <br /> -y s <br /> a <br /> Zoog <br /> r � o <br /> z <br /> m <br /> V / O O �'Z <br /> 0 � ` ill/// opt_ Q 7 <br /> a _ F <br /> a rr < m� ,�Im m <br /> Z C, 0 70 <br /> in 3 <br /> vo 70 <br /> ......... ....... ........ .................... o c <br /> Signature of Owner or Agent ate <br /> m m <br /> Remarks.:�4..�C.�.y/�c.�...r�."`..r�...?.......................... .............................................................................................. � 0 <br /> ........................................................................................................................................................................................ <br /> n <br /> ..................................................................................................... . .... 7l : <br /> ....................... ........ ....�..J........ <br /> Inspection Date ....................................... ??...? / .f"Qaze , �E « T <br /> ...... YZ ....................................,,�...fi?.c:................. i i 9N' a o � oam <br /> Zoning Administfator 8 8 8 8 8 8 0 <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 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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />