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Int'-C'7e, <br /> Burnett County Office of Zoning Administrator 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 <br /> < — <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Laud Use - <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis onsim _ n. <br /> 0.� .�. .ubC.11............................. ....... . . . . . ..............................................................'L........ <br /> OWNER (p14e print) �/ I CONTRACTOR or SURVEYOR or AGENT I a <br /> .......�t..v...e ............................................................................. ........ <br /> ADDRESS — ADDRESS <br /> Cr I (7r <br /> P ..................I......Ty.. !..5......l7.NS /J ADDRESS..................................................................L......... i 1 <br /> .......... <br /> .I .... <br /> ADDRESS <br /> .L......... <br /> ........................................................................................... ..........E...................................................................... i <br /> l' <br /> PHONE. ............................................................................... PHON <br /> ............................................................................................ <br /> PLUMBER WELL DRILLER aL1 <br /> ....... . . ........................................................................... . <br /> ... A. .. . ..................................................................... ......... <br /> n <br /> ADDRESS DDRESS n o <br /> ........................................................................................... ................................................................................. .......... o ,» <br /> PHONE PHONE 1 H <br /> z r <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms IL......... ? o / �— <br /> New BuildingType of Cons ruction: No. Bedrooms .......... U� <br /> Addition � ...... µ e. .L7.......................... Septic Tank Size Gals. .......... r <br /> .......... O: <br /> Sanitary Size ....1..0.... ft. x ....2 V... ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Soil Type . .......... r <br /> Moving .......... Area ........................... ............... .................. ...... <br /> o <br /> Mobile Home .......... Slope ............................... .......... <br /> Privy ,......... 3. Use (describe exactly, 1 -family Pere. Rate ........................ .......... <br /> Well .,,,,,.,., home,garage, motel, etc.) Dry Well ........ TTl { <br /> Subdivision .......... .................................................... Seepage Trench ....... <br /> . r <br /> Camping Unit Privy .......... <br /> ............................ <br /> .......... ........................ <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be, sketched in Fig. A. Inclu to rood Q <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property Is located at a highwl v Inter a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX STING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. w o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ...J.�?.d ft. x S .Q.... ft. — sq. ft. I <br /> ... ............................... ................................................................... .........., I <br /> d <br /> -� vs <br /> m <br /> 'aN o <br /> t o � <br /> oo v� <br /> 0 <br /> p t L pu5e 7 I I z 1,0___ - J :c <br /> F <br /> N d m <br /> Ocn < y ,� m <br /> m p <br /> Z OO <br /> n 5 <br /> in <br /> � o <br /> 0 <br /> o c <br /> Sig at re Owner c r Agent Date <br /> X <br /> Re arks TI : n <br /> ................................................................................................................................................................I........ C <br /> ...................................................................................................................................................................... ................. — <br /> ........................................................................................................ ..................... .. ...... . . . <br /> ........ <br /> IV �.... N N + W + N <br /> Inspection Date ....................................... "" ... { n <br /> / Zonin Adminis rotor o 0 0 0�0 <br /> /71 <br /> NOTE: A preliminary site Inspection must be made and site approval granted on all structures Ievolving sanitary facditwV <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolati n test must be attached to <br /> this application before a permit will be Issued. Do not purchase or install a septic tank, do any p umbinq 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 be made without approval of the Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />