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0YI-2 C <br /> County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITNNI <br /> a 3 <br /> 1E ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < 7C` � <br /> 0 <br /> herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordina^.ce, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 M viv <br /> �j /_ , = a O <br /> ..... ..../'t:.....I!✓F. !..:...':f.................. ............................................................................................ "= <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m m <br /> .........`oil a.....�a�I.r.N...U,.«..�z ............... d <br /> . . .. . . . <br /> ADDRESS ADDRESS ' <br /> ❑DBEs ADDRESS <br /> �a� y� ............ � <br /> .............................. ................................................. <br /> PHDNE................................................................................. PRGNE <br /> PLUMBER WELL DRILLER :U'\ <br /> ........... ............................................................................... . .. <br /> ADDRES.............................................................................. O .O <br /> ADDRESS S <br /> o <br /> _. <, i <br /> ........................................................................................... ............................................................................................ o _ <br /> PHONE PHONE z H <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: o ° <br /> 1. Work: 2. New Building Details No. Bathroomso ' <br /> .......... <br /> New Building Type of C nstruction: No. Bedrooms .......... <br /> Se tic Tank Size Gals. .......... <br /> Addition .� . ..'. .............. .:Q.!9'.CL7.. ................ P i <br /> Sanitary .......... Size .......... ......... <br /> '�y. ft. x ....,�,y`. ft. <br /> F i l l i ng f G rad l ng ......., Height............. Stories ......1....... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... 'i r <br /> Mobile Home .......... Slope .......................................... 0 <br /> Privy .......... 3. Use (describe exactly, i -family Perc. Rate ................................ � <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... [ <br /> .......... C7ed e-....................... "I'................... <br /> Camping Unit ......,... Privy .......... <br /> ------------- Seepage Bed .......... <br /> -------------------- <br /> ------------------------------- be t� <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- _d <br /> section, show the intersecting highways and the setbacks required along them and at the intersection- CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS---------------------------------------------------------------------. <br /> 0 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> .....�ys?. ft. x .. .dP ft. — ............................... sq. ft. ............................................................................... i <br /> L �C C vt <br /> � � N <br /> 0 <br /> N 0' <br /> O = <br /> A <br /> h <br /> L <br /> � m <br /> �7 VIr � Hm Z <br /> n Q = < m c m <br /> E <br /> m N< c: = y a m <br /> OH. m y n <br /> oZ O O ¢a 31 <br /> m <br /> —t L un 3 <br /> AA m <br /> — <br /> [ fJ �vvvL� .................. ..........'7j ° d 3..... 0 0 c <br /> Signature of Owner or Agent Date X <br /> m <br /> Remarks ......................................................................................................................................................................... m m � <br /> m <br /> e <br /> n <br /> ............. .......................................................................................... . .. .. 1� <br /> Inspection Date ....................................... ..W .:�1.. . ........ .....?'!.................... E E 9Nr o it 8 a m <br /> Zoning Admi strator /cJ 8 8 8 8 $ $ ai <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 he 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 he revoked if misrepresentation of any of the information conveyed here- <br /> with Is found to exist. Changes in plans or specifications shall not I>e made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />