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Burnett County Office of Zoning Administrator d 0 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 < m <br /> w <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Cade, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsino- <br /> .... ....... <br /> . . . ............ . .......................................................... F <br /> a <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> O.0 . . �..�.....B..v... r....z/.a......................... ............................................................................................ d <br /> ADDRESS ADDRESS .. <br /> ��.✓ rc0.5..7.............. ... . . . . . . <br /> AD/DRESS ADDRESS <br /> ...([7..f�..:—... .. .. ....... ...(...[1...r1........................... ............................................................................................ w <br /> PHONE .... PHONE - <br /> . .�.�.......�L�crnh.��r ... ......_......L .%�✓.9� fo.�1.....1 �.L.L............. <br /> PLUMBER C WELL DRI LCLER //' <br /> . . . . . .5'✓. 1Q..Q.N. .I>?.. ... .��..S.0...:........... ..............v. .QQ.GSI:E. Wit✓d...J.C.J................. <br /> ADDRESS ADDRESS 1 <br /> : <br /> . ...................................................................... .............................................................................. <br /> PHONE PHONE O <br /> .. ................ . <br /> Z H <br /> DESCRIPTIONr <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building X Type of Construction: No. Bedrooms .......... a i <br /> Addition .......... ..,,,,,.. ,,.....,. ,,.. Septic Tank Size Gals. .......... <br /> .....).......... .. ... pp..... <br /> Sanitary .......... Size ...../..�?.. ft. X .... :.0.. ft. ......... <br /> Filling/Grading .......... Height........... Stories ....f......... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... <br /> Soil Type ....................................... <br /> Mobile Home Slope . ...................... ..... .... ... °r <br /> i <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate ................................... p <br /> Well home,garage, motel, etc.) Dry Well .......... 9'�' <br /> Subdivision Seepage Trench .......... <br /> �.42A. ..c.....LV L. .f7....... STh t <br /> Camping Unit .......... ...�/h`(/ ✓�. Privy .......... <br /> . . . . .... .. .... .. <br /> Seepage Bed <br /> location of proposed structures and existing structures well, sewage systems, roads, etc-, should be sketched in Fig. A. Include road <br /> Q <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 /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p p' <br /> __.__ —__ N . <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x ........... . ft. . sq.ft. o <br /> 3 . <br /> .20V il�j <br /> N T n <br /> U ° <br /> Ts•,r <br /> a <br /> I T <br /> Z <br /> O p <br /> I 1 Cove � s� fl: --FFo�ry <br /> Qbrcf+iNai <br /> yrs Id� <br /> SYauYr� %.aroK� <br /> i � cnrv � moo <br /> m c w c m <br /> N N d n d 4 W <br /> C <br /> Z O O D n <br /> O O a 3 <br /> fA - <br /> �o . � <br /> p � m <br /> .. ... ... ..... . .... .. ... .. .. .............0..:.......c ."?�J X90 C_ <br /> gn�f caner or en Date <br /> RemarksQ..(J.. !-7 ' X M <br /> ......................................................................................................... m <br /> i <br /> ter <br /> _ <br /> tv II <br /> ...................................................................................................... ..... ...................... <br /> Inspection Date ....................................... ... ./`z'.�... .,.....�.................. �O: o, o o N m <br /> Zoning Adminis attf or �✓ ' 8 S 8 S S 8 vn <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 no attached to <br /> this application before a permit will be 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 be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not b2 made without approval of the Zoning Adm Inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />