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Burnett County Office of''L6ning Administrator 0 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 locate( as � m <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Jse m c Q <br /> Ordinance, Sanitation Code,/and with all other applicable County Ordinances and the laws and regulations of the State of WWiiscon in. 0 <br /> Com. la XF , <br /> ......7�o....?yto�'�c?.tai..................... ......!V.C?n.d.. .... 3t) .T . CONTRACTOR or SURVEYOR or AGENT <br /> ADDRE p ADDRESS <br /> .:. ............ .1 :,nca..... � S�G� s... ..?i ..)................... ..... z <br /> ADDRESS <br /> ADDRESS _ s. <br /> jP/�-......: .... .....`.. y. / /_ /1/ .2... ................ ' <br /> PHONE ' 6 �l...K/I............ .PHONE..... :!.:.r:!..J..........5 ................,� ..... i <br /> PLUMBER WELL DRILLER <br /> O <br /> ADDRESS............................................................................ .ADDRESS.................................................................... .. <br /> » O <br /> ........................................................................................... . . ............................................................................... ..... j ^� <br /> PHONE PHONE Z r J <br /> DESCRIPTION 4. Sanitary Facilities: o 0 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .... ..... o <br /> New Building ....../,,, Type of Constr Vction: No. Bedrooms .... ..... <br /> Addition ...Y..... .....44t�ly��.U../.-L?/.'sL7:).�'........... Septic Tank Size Gals. .... ..... <br /> Sanitary <br /> Size .....�.Q... ft. x ..Z.U.... ft. � .... ..... .� <br /> Filling .......,., Height............. Stories ....j......... 4a. Absorption Field Site: . <br /> Moving .......... Area .....3'`.�..J..:�.tf.C[C. Soil Type .............................. ..... .17 <br /> o \ <br /> Grading .......... -P &X JO Slope .................................... ..... » <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Pere. Rate ............................. ..... i <br /> Privy .......... home,garage, motel, etc.) Dry Well .... ..... <br /> WellSeepage Trench .... ..... i <br /> Subdivision --------- .-----------------------------------Privy <br /> Seepage Bed .. . ..... <br /> ----------------------------------- <br /> n <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig, A. Include rad <br /> CP setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway ter- _a <br /> section, show the intersecting higDways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 7' <br /> N o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p <br /> ---------------------------------------------------------------- <br /> 5. Lot S!Ze: / Fig. A. 6. Location: <br /> ..JQ.V..... ft. x ..(w 4..4�.. ft. — rd :.f........... sq. ft. .. <br /> .............lCr /F. . . ....:.e?k1tu�. ...:19 .. ..L. <br /> L X W <br /> n <br /> N o <br /> o � <br /> y je„1 g <br /> —' <br /> 1993 + i <br /> 35� <br /> � a <br /> �'P n <br /> tAv <br /> V l :N <br /> ate• <br /> 7j cnrv � cnm Z\ <br /> c m m <br /> -o rn a C , i « :E m <br /> o <br /> ... <br /> ..- rn <br /> .......... .............. ........................... f�nn o <br /> Signature of Owner or Agent t.. C <br /> Date -�J x I o <br /> Remarks ...................................................................................................................................................................... .. <br /> „ : v <br /> m <br /> s <br /> --II <br /> ....................... ... ................... .. Q <br /> oe <br /> 000 oNm <br /> InspectionDate ....................................... ...... .......�.�..�...... .. -L.��'��......—........... � 0 0 0 0 o m <br /> Zo 'ng Administrates 0 0 0 0 0 !n <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures invc lying sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation tf st must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plum ting 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 mistratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE A D APPROVED. <br />