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Burnett County Office of Zoning Administratord o 0 <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 located as :X, <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 ma ✓J ?CJ` <br /> ` t a o <br /> 6. d 5 .Lu kjv ti. ......... ....^ L1........................ - <br /> OWNERR (please print)C'� •f— CONTACTOR or SURVEYOR or AGENT o. m <br /> ..........s l:�� 6�.......YS..f..:................................................. .........la.O.X....Z.Z�................................................. <br /> ..... a <br /> ADDRESS ADDRESS <br /> W ti b 5 ;r W �E B9 3 rv>... ....................................S t! o o / <br /> ...,.... .....:........ <.Y..... r <br /> �/CJ� �I ......................... <br /> ADDRESS ADDRESS <br /> ................................................................................ ... .......7.3.5-... .6.�a... .y.So.S'................................ <br /> PHONE PHONE <br /> ........................................................................................... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... . .......................................................................................... <br /> � ; <br /> ADDRESS ADDRESS <br /> 0 < <br /> � o <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .. .. <br /> New Building Type of ConstructNo. Bedrooms .....-11 <br /> Addition .,./�s.A,d,,y j�qy� ..... •I,r Septic Tank Size Gals. ..7..1 J <br /> Sanitary .......... Size ......./(v... ft. x ....b.0.... ft. .......... .� <br /> Filling/Grading .......... Height.....(3��.. Stories ......./...... 4a. Absorption Field Site: i <br /> Moving .......... Area .......�i.P.-?. '....5.* %--r.. Soil Type ........................... ........ : r <br /> Mobile Home Slo e <br /> ra o <br /> .......... P .......................................... e : . <br /> 3 <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... E <br /> well .......,,, home,garage, motel, etc.) Dry Well <br /> .......... <br /> n <br /> Subdivision .......... ' Privy r <br /> „ „ .........lP .4lnri. Seepage Trench .......... A <br /> Camping Unit • ••••, 1 ' <br /> A ......... .................. .......... , <br /> Seepage Bed .......... <br /> ---------- p <br /> ----------------------------------------- o rn <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 /> Cr <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING A' <br /> b <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. t o� <br /> ---------------------------------------------------------------- <br /> 5. Lot Size: Fig, A. 6. Location: w :n <br /> x.94. ft. x .3.�o.tPf"fc — ...t1�p,�,.,I.Ls�ccc. sq.ft. ............5.:fC...ae.... .... .0.Iv.. .J..Y...ssl.... 3 <br /> 0 <br /> O c <br /> N <br /> A <br /> IN <br /> O O <br /> / n��te T- <br /> be <br /> a <br /> � U� �/�,� <br /> Y11 CClu I4 Y' � �O <br /> 4. ia,6'6k oN z <br /> 0 <br /> So NE N�s FrSws�<fiw( 5- <br /> w��krK <br /> oil <br /> /t 7g Nr � � mm <br /> 1,04 <br /> m <br /> Tr2 Nch. (It < w <br /> z o 0 : : m <br /> C. 'Twr `� _ a a <br /> o <br /> Te <br /> p <br /> 0a"Ae �f(6��, ne%VAgen : <br /> E�o C <br /> Remarks .✓..a .?'W. o7... <br /> 75 x : M <br /> m <br /> ........................................................................................................................................................................................ <br /> :13 II <br /> ........ .. `o « m <br /> ................... <br /> Inspection Date ....................................... U' N o N o $ <br /> .. . m <br /> Zoning Admi lstrator $ $ $ $ $ $ cn <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 riot 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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />