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Burnett County Office of Zoning Administratoro 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3. e <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < H JJ <br /> :-�s <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use � c .00 <br /> Ordinance, Sanitation Code, all other applicable County Ordinances and the laws and regulations Staie of WI In. 3 0_ <br /> PP g scons <br /> fid/ ✓ � �-C- H o <br /> '... <br /> OWNER (please print) CONTRACTOR r SU RVEVOR or AGENT m i m <br /> 1'�o.�.. <br /> ....... ........5 .'�... t2�Z <br /> ... . ............. ................................s.�..................................................... <br /> ADDRESS ADDRESS .. <br /> 122.v SSW 7 <br /> .................................................. ............................................................................................ <br /> ADDRESS ADDRESS <br /> ............ <br /> ........................................................................................... ................................................................................ <br /> PHONE PHONE <br /> ........................................................................................... WEELLL L. '' , DRI.........LLER........................................................................ <br /> PLUMBER <br /> ........................................................................................... <br /> ADDRESS . .......................................................................................... O <br /> ADDRESS 0 <br /> n o <br /> . . . . . . .................................................................... .......N'.................................................................................. <br /> PHONE PHONE Z o <br /> DESCRIPTIONN <br /> 4. Sanitary Facilities: ° o 0 <br /> ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details u <br /> New Building .......... Typeyy.f�Construction: SepNo. Bedrooms .......... `\ <br /> Addition ,,,.,, F'iSeptic Tank Size Gals. .......... <br /> ................../..�........ ....... ... .. <br /> 41 <br /> Sanitary .......... Size ....Z,.W.. ft. x ... ... ... ft. .......... i <br /> Filling/Grading 4a. Absorption Field Site: <br /> .......... Height..... odes ............... r <br /> Moving .......... Area Soil Type .................................... SVS •r i <br /> ....................... <br /> • o <br /> Mobile Home .......... Slope ...................... ................... 0 <br /> Privy .,,,.,,,,, 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Wellhome,garage, motel, etc.) Dry Well .......... <br /> .......... v <br /> Subdivision f Seepage Trench ..... <br /> .......... <br /> Camping Unit Privy ..... �t l <br /> Seepage Bed .......... <br /> —.----------------------------------------------- --------------------- Vl <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 <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------__—_--_-------------__------------- � <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... !� <br /> 41 <br /> � r N <br /> 0 Za <br /> s <br /> 551 0 €C>v <br /> b 0 <br /> ap <br /> T7V <br /> I - <br /> s <br /> 75 ^ 4 z 4 <br /> { <br /> 7s, cit <br /> 9 N r M :EW m Z <br /> a 70, <br /> re'i 9- " — w " aa <br /> �' to < <br /> > -' rn <br /> Z 0 o n <br /> o = iii 77 <br /> � o � <br /> Q a M <br /> ..................... ................1..................... o c <br /> Signature ofLOwner or Agent ,J Date <br /> Remarks ...,1.-?.e1. 'G»?�'�-- ..1rt.`' /l 9��3 x 70 <br /> .. . ...... .... . ........................................................................................................................ 0 <br /> n ' <br /> n <br /> ............................................................................................................ ... ....................�.JJ................................................. , <br /> Inspection Date ....................................... L>19r7:!�+�.l..:....:J........ ........ �' N ry 8 m 8 N T <br /> .. ...... .. .Lf.............. rn v, oaoa <br /> Zoning Admi istrator T U 9i 8 $ $ 8 $ <br /> NOTE. A preliminary site inspection must be made and site approval yrented on all structures involving sanilary facihtics <br /> before construction can begin. In the case of sewerage disposal systems, it 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 statt any build- <br /> ing until a permit has been issuer). A permit may be revoked it misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />