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Burnett County Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o :1a <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use C ;\k <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> Dv. ..........lQ..n1. .................. .............cSf �2I ....................................................... " <br /> ........... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> Cz.....! .................................. ............................................................................................ a " <br /> ADDRESS ADDRESS _r i <br /> ........ko.. ............................................................................................ \ <br /> ADDRESS ADDRESS <br /> AA :4 <br /> .............N..'"T:................. C�� a ! <br /> PHONE PHONE <br /> n i <br /> ...............11�p. .N......... !��?!.=. t.T............................. ............................................................................................ �r <br /> PLUMBER WELL DRILLER <br /> ............................... ............................................................................................ o ' <br /> ADDRESS ADDRESS m .0 <br /> �. ...3.5 ° <br /> 0. < <br /> ................ ...:....................................... ............................................................................................ ° O <br /> PHONEPHONE M <br /> z H m <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ... o i <br /> New Building .......... Type of Construction: No. Bedrooms ..u.{... r; M :-1 <br /> Septic Tank Size Gals. ..�.:� <br /> Addition .................................................... <br /> Sanitary Size .............. ft. xft. <br /> ..... ........ <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .........SB.N. .. .:........... , <br /> m <br /> o <br /> Mobile Home .......... <br /> Slope ...................1..IGl...s C,.. ° <br /> Privy .......... 3. Use (describe exactly, 1 -family Pend. Rate ............ ...... ........... i <br /> Well ,,,,?,t,,, home,garage, motel,etc.) Dry Well .......... 1 7 <br /> ^ Seepage Trench `. <br /> --Campi <br /> Subdivision .......... c <br /> .......... ..... lT�1.I'A..�................................ <br /> Privy .......... <br /> Camping Unit .......... .................................................... <br /> Seepage Bed 1-----...... ut i <br /> U � � <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road y, CF NLB <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- u' °; <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING °O <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. uJ o f o <br /> 5. Lot Size: // IIT� Fig. A. 6. Location: <br /> lf�(2..... ft. x .rp.�.v... ft. . ............................... s9.ft. ... . . ..........1-../191...... .0....D.r�....!7.wzl77. <br /> 3 <br /> v� So Spbr Pvz� C ons <br /> N O <br /> O A O <br /> D Jxx <br /> � <br /> W <br /> p O <br /> 1�V � <br /> 'V S <br /> T \ <br /> A n f <br /> M IQ L14m <br /> oNm ; D <br /> o am <br /> Z o o n 70 <br /> � nro 3 <br /> p <br /> Signature of Owner or Agent � D to C <br /> Remarks ..(!./.� ,,.rra.....C-,0.::1 ":Y.'.-t. T x m <br /> M <br /> ........................................................................................................................................................................................ — : : : <br /> .......................................... .. ...........✓ ..... U' . . <br /> /= LL — X80 m <br /> Inspection Date .J.......... ....................... ....... ..... .....��%i%,Wf ... .................................... :� _ m <br /> Zoning Administrator <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 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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />