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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d' 3 w <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> �� ��„„ Vl/ u5.....``�-^^ --vv''ff''�� £ / pA.. .EL. INC" H <br /> OWNER (please�int.VCONTRACTOR SURVEYOR or AGENV.[�... f...... a _ i <br /> 57.3.... .SAG ... K.....R...D...................... ..... .. ........ . . <br /> ADDRESSADDRESS .. . ...................................................................... a <br /> 5 ��. w... M N r w `�..................3..... <br /> . . .. ............. ........ .... . ............. <br /> . .... ...w..�S.G.......... <br /> ADDRE ADDRESS <br /> ►.�.W....................... sv <br /> PHONE ............. .PHONE................................................................................ <br /> ...WK.412. 3...7.sb7 ......... �.1.5.-...Bf�C�....`�.!.`..7.7.............................. <br /> PLUMBER WELL DRILLER ' <br /> ADDRESS .ES................................................................................ <br /> ADDR �_ 'GS <br /> 0 o f <br /> ........................................................................................... <br /> ............................................................................................ <br /> PHONE PHONE :-. <br /> DESCRIPTION 4. Sanitary Facilities: ° o » <br /> 1. Work: 2. New Building Details No. Bathrooms ........ . <br /> v <br /> New 6ulldingType of Construction: No. Bedrooms ... ... <br /> Addition .......... .................................................... Septic Tank Size Gals. ... i <br /> Sanitary .......... Size .............. ft. x .............. ft. .15b GAL' <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving ......... Area ........................................... Soil Type .................................... <br /> Mobile Home ... Slope .......................................... <br /> rs/AJLT) .... ..... 3. Use (describe exactly, 1 -family <br /> Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well <br /> Subdivision •......... Seepage Trench ..... <br /> ........I...... ..... l ; <br /> Camping Unit .... Privy .......... <br /> .................................................... Seepage Bed .......... _ i—lT� i <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- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING J 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ) o <br /> ---------------------------------------------------------------------- ! <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> On <br /> N <br /> e <br /> 5 kTirkCt o <br /> o � <br /> 4 <br /> :� <br /> mz <br /> o � <br /> d <br /> _ m <br /> n o < m c m <br /> EA F <br /> LD. <br /> N O; ,c <br /> m ' <br /> Z y a T <br /> o �0 <br /> S9pSi ...h.�. Vate <br /> gnature of ner or Agent » � � C <br /> x 70 <br /> Remarks ................................ m m <br /> ....................................................................................................................................... m : <br /> .............................................. ............................................................................................................I............................ <br /> ......................................................................................................... ..... <br /> 1. <br /> ........... <br /> Inspection Date ....................................... . <br /> . .... dam........... <br /> dm ........... HN Nm <br /> r„ oNm <br /> Zoning in istrator N : $ $ $ co <br /> NOTE: A preliminary site inspection must be made nd 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 be made without approval of the Zoning Adminlstrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />