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Burnett County Office of Zoning Administrator' <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ; 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and � M <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m i <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and he laws and 3 <br /> regulations of the State of Wisconsin. n / <br /> . ............................................. . .r! r.. ..l..e....... .��.. .. v. 9......... c <br /> r <br /> OWNER�glease print) C-ON RACTOR or SURVEYOR orAT jkA <br /> .. ..../L:•�1.. ..... / ��h ................/..... .Ao EsI.............6.r21...............f................................. y <br /> ADDRESS- <br /> 1 ;cp <br /> ......`.S`..'J/,� . K . ..I... .,.........G..v..........N�..`7......�..7..,:.. = C� <br /> ............................................................. . . <br /> ADDRESS ADDRESS Fj Gl <br /> G... ..y. ..3. '............................................. <br /> PHONE PHONE ' <br /> ........................................................................................... <br /> �................f�r..iz�l................................... :y <br /> PLUMBER WELL DRyLER <br /> .......................... ..CP `s.....� ( !(/.f. ............................... :V� 'o <br /> ADDRESS ADDRESS n C <br /> .............. N <br /> .......... <br /> . .................................................................... ^' <br /> PHONE PHONE......... Z <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o i <br /> New Building ,,,„/if Type of Construction: No. Bedrooms .... s <br /> Addition Septic Tank Size Gals. `\ <br /> w.cra,l...F.►rxc a� ................. 00 2 <br /> Sanitary Size ...'d.• ft. x . a .. ft. •• • .� <br /> .......... ..... .. <br /> 4a. Absorption Field Site: <br /> Filling/Grading ,,,,,,,,,, Height.... St les .../........... :U�j <br /> Moving .......... Area K Soil Type .................................... i <br /> ...........(.�. ........ ......... C <br /> MobileHome Slope .......................................... » <br /> Priv Perc. Rate ................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family o .n <br /> Well ,......... home,garage, r9otel,e .......... <br /> etc.) Dry Well <br /> Subdivision ... .... . .&Kd .....A&..!K.CI...... Seepage Trench .......... o <br /> .......... <br /> Camping UnitPrivy .......... <br /> .......... .................................................... Seepage Bed <br /> ---------------------------------------------------------------------- U) :c� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Q R� <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at - n <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. 1— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :� o <br /> —— ------------------ <br /> 5. Lot Size: ,�. ,? Fig. A. 6. Location: / .�{ <br /> ...�Q.Q..... ft. x -3OQ.tft. — ..,.O.ao.d...... sq.ft. ....... . . ...........S.ti e...... -1L.. RA <br /> 0 <br /> /001 <br /> o <br /> 60/ Nvl�, k Tam K ra <br /> f y $X 3� 0 c� JC uo C) it c ✓ -7)a a <br /> 26 - Ij : m €��a <br /> . <br /> sit � ted ` <br /> ;L <br /> �3a <br /> 7 U n <br /> SS <br /> (east 3a M 0Mvd > coca m <br /> ROS t�'�a /r m �nc amaa9 <br /> d C y J J ; <br /> 0 m CD <br /> D <br /> o c m <br /> 20 : D <br /> ../..J... .. x A : G <br /> _ C <br /> Signature of O r or A t Date c <br /> Remarks .................................................. .................. .... ... ..................... <br /> 1�-.—................ <br /> .... <br /> ......... <br /> ... . ........... _ <br /> ............... ir.;�.e. .. ............................ ............... / .............{1.................................................I <br /> .......................................................................................................... ..... .............. .... ..Inspection Date ....................................... ..ning........... .trat............. SSSS 8 <br /> Zoning Adm' istrator <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />