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Burnett County Office of Zoning Administrator g�g <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 <br /> M, <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describedland <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the W <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the Stateof Wisconsin. a <br /> Gfl. l ...d. xqm. . . ......�n?. .s ................. .........5.... ..............................................................G...... <br /> OWNER lease LLrind 1 l CONTRACTOR or SURVEYOR or AGENT <br /> .lZ� l.......1..1,4 �.1.tM ..4�+�. ............................ . ...... . ..........................................................................i....... 'a i <br /> ADDRESS 1 ADDRESS ' ' .0 °� <br /> ................ <br /> .................................................................................1....... <br /> ADDRESS ADDRESS <br /> ....4.Nf. QsNbu�. .. .ln).i.5... 5.9..8.. .a.. . . . . . .......................................................................... ....... <br /> PHONE <br /> / 22Cy ` 7 Nk p�7 1�ER ,, ) PHONE {I �� •'� <br /> PLLUMB1a..✓..1.�.J.�/.W�.4......�,i~?..�..SJ.S..I.I./.hp1.5 WE LL DRILLE.R...........................................................�....... <br /> I <br /> S <br /> O _ <br /> ........................................................................................... ..A......RESS.. ...... ....................................................................I....... _. <br /> ADDRESS DDn <br /> G........................................................................................... ................................................... ............................. <br /> .. ....... o .i <br /> PHONE PHONE i Z « r <br /> DESCRIPTION 4. SanitaryFacilities: P o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details " """' i o <br /> New Building ,,,, Type of Construction: No. Bedrooms .... ., <br /> F IZ .. ... <br /> Addition Septic Tank Size Gals. .. ....... <br /> . ....... <br /> Sanitary .......... Size .'t".1... .. ft. x ....�.0'L..£ ... 4a. Absorption Field Site: <br /> FIIIInglGradinp ,,,,,,,,,, Height..�'.A':.. Stories ...�....... . <br /> SoilType ............................ ....... i r <br /> Moving .......... Area ......................................... o <br /> Mobilo Home Slope ..................................�....... <br /> .......... <br /> Privy .......... 3. Use (describe exactly,"! •family Perc. Rate ...........................�....... <br /> Well .......... home,garage, motel,etc.) Dry Well '• <br /> .. ....... <br /> `� i� Seepage Trench o <br /> Subdiact. , <br /> vision `a.C, ..!„D,K .u....... ..... <br /> Camping UnitPrivy .. ....... <br /> .......... ................................................... <br /> Seepage Bed ..— <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi 3. A. (J1 C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is locai ed at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. — :(� o <br /> ------------------------------------------------------------------- o <br /> 5. Lot Size: Fig. A. 6. Location: ` ( <br /> ................ ft. x .............. ft. — ............................... sq.ft. ...................................................................... ....... 00 <br /> . <br /> 00 <br /> N � O <br /> O n' <br /> O <br /> Z Z <br /> O <br /> I a <br /> 5'�F A7-7 A C HE CS <br /> 31 mvmr Dco W -0 <br /> n <br /> ti a�Fno < > > EL <br /> m — a M m aa y <br /> omm � m " m !n' '= <br /> Zgo � 0D •i <br /> 9 N� yn : <br /> 7y/ $�'�/ 2 <br /> = : m <br /> ¢// m <br /> nature of Owner or Agent Date $ <br /> m y . <br /> Remarks a <br /> » : H <br /> ..................................................................................................................................................................................�..... o <br /> '^/ $ . . <br /> Inspection Date ....................................... ..(./.J�.��/.p.'`. -..�........7:t.G.'.< . . ... . .. . ..L.... 8 m <br /> Zoning Admini r for g g g W <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app cation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANDA PROVED. <br />