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3urnett Coun'y Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE BUILDING PERMIT 3 a <br /> o ;(tl <br /> "0 THE ZONING ADMINISTRATOR: The undersigned hereby makes application for aPermit for the work described and located as '� 0 . 11 <br /> u <br /> gown herein. The 'undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e � !� <br /> )rtlinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a v l <br /> a O <br /> '^ <br /> ..r •e :,.. ,.:;ur 'i«rv.iez�paA�t 2 F <br /> :WNER (Please print) CONTRACTOR or SURVEYOR or AGENT a <br /> DDRES•. . S........o•.........i.-._............D..t.3..1..U..�..)...y.......±.1.......]....,F...l.._.i.. <br /> ..... ............................................................................................ <br /> ADDRESS v) <br /> p <br /> ......................................................................................... ...... <br /> '\\.., 'N <br /> .................................................................•............. ............ J. <br /> ,DDRESS ADDRESS �. <br /> HONE PHONE <br /> ......................................................................................... .WELL....... ....D. .RIL.... L...ER....................................................................... <br /> LUMBER <br /> ,DDRESS ADDRESS <br /> n O ' . <br /> A <br /> ......................................................................................... .......PHONE..................................................................................... :Z o M <br /> HONE � <br /> DESCRIPTION 4. Sanitary Facilities: •° o 0 ;r <br /> Work: No. Bathrooms N/A v fir" <br /> 2. New Building Details o <br /> New Building .......•.. Type of Construction: No. Bedrooms r'?!.?`..... <br /> I i <br /> Addition %'r".' if Septic Tank Size Gals. P1,/A ` r- <br /> .y...... ...... ........................................... .. ..... <br /> Sanitary .......... Size ... ::y...... ft. x ...l.y....... ft. .......... i C <br /> Filling .......... Height..:d......... Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ...... Soil Type ........................ii..''..... <br /> Grading .......... 140 Sq ft. Slope .......................... ...N. ..... p <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Pero. Rate ..................... • • <br /> Dry Well <br /> Priv AI .r...... -� <br /> V .......... home,garage, motel, etc.) <br /> Well my n Seepage Trench <br /> ....7, C}...... Afj.iilt].. A............. • . E-� <br /> Subdivision .......... Privy p3/A..... <br /> .................................................... Seepage Bed N/A..... <br /> ------------------------------ ____--- a... i <br /> ocation of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig. A. In road e <br /> .-tback, side and back <br /> yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o- <br /> action, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING Va . <br /> TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> _------------------------------------- _---__—_-----__--_---__--- 1l <br /> . Lot Size: Fig. A. 6. Location: ET- <br /> .al ft. x �.( .. ft. —13' Xz sq.ft. -n.C.a...�.7...1f rf i.l "id: ............................... <br /> t <br /> :IT <br /> N <br /> _ nsi <br /> O X <br /> _ f. <br /> f r cr F E`r o ' <br /> M <br /> C m <br /> i ^ <br /> l rnry m <br /> c m <br /> FA �' <br /> / "� 1 p <br /> ......................... ...... ..................... ° <br /> ignature of Owner or Agent Date o C <br /> X i <br /> lemarks .................:................ :::. - - ' T E m <br /> m <br /> ...................................................................................................................................................................................... <br /> II <br /> ....................................................................................................... ..... .Y.. <br /> ispection Date ....................................... ; ..: .1: (.?..:�,........ < l:'.�6� <br /> . . ............... 000000m <br /> Zoning Administrator 0 0 0 0 0 o N <br /> DTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> More construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> is application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />