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eq—rl( >' 0 . <br /> Burnett County Office of Zoning Administ ator a 0� 0 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 loc ted as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lai d Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis onset. 3 a �I <br /> e4./le. Al...BOSS.... .!4.RSo..n................... .............................................................. ......... o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a +, <br /> �3�>X....`j..5..... rF4..N.. ......................................................................... ......... <br /> ADDRESS ADDRESS <br /> ........................................................................................... .................................................................................. ......... W <br /> ADDRESS ADDRESS :nn <br /> .................................. . . . .. . . .... .. .................................. .................................................................................. ......... <br /> PHpyE PHONE :0i <br /> ................................... .................................................................................. ......... \ <br /> PLUMBER WELL DRILLER iGo i cj1. <br /> . .'5.3............... .................................................................................. ......... <br /> ADDRESS ADDRESS - <br /> O <br /> 0 O <br /> . , <br /> ................................ .................................................................................. ......... - <br /> PHONE PHONE Z m r- <br /> L11 <br /> DESCRIPTION 4. Sanitary Facilities: PC�1 0 o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building .. Type of Construction: No. Bedrooms <br /> Addition Septic Tank Size Gals. .44 <br /> .. ...........t..'ei <br /> Sanitary „a Size ........ ft. x ....�..CR.. ft. ..••.•.•• <br /> Filling/Grading .....,.,.. Height............. Stories .....�........ 4a. Absorption Field Site: // <br /> Moving .......... Area .....Iz.`�.&..SQ..' i-:. Soil Type ...,�j.•.l :.N.4':.... .I....... m <br /> ........... o <br /> Mobile Home $lope .............. » <br /> ..... ............ ......... <br /> Privy ..... 3. Use (describe exactly, 1 -family Perc. Rate ......................... ......... <br /> ! ,,, ,,,,, home,garage, motel, etc.) <br /> Dry Well ......... <br /> Subdivisionh T <br /> S <br /> ,,,,,,,,,, , eepage Trench <br /> (.:.Frtrn.tYnrr.ti<. !-'i <br /> ............. <br /> Camping Unit .....I.... Privy <br /> ____ Seepage Bed . ....... i .t <br /> Ge <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Incluc e road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If - <br /> property Is located at a hlghwa inter. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABtL EXI TING (� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> ________________----__-_------______-- -_________-_------________-__ __ <br /> 5. Lot Size: A UpeS Fig' A. 6. Location: N/t <br /> ................ ft. x .............. ft. . ............................... sq.ft. .................................................................... .......... : <br /> m <br /> Sir V0 <br /> n n <br /> 0 <br /> a <br /> 1 <br /> Z <br /> 0 <br /> d <br /> m <br /> ti <br /> M (nr T Nm Z <br /> CC <br /> T N <br /> Z m <br /> Oom D n <br /> i» — <br /> o .{ <br /> o <br /> J� m <br /> i C om. .. . ... . .................. ..... CrfIST..I(t.�g87 .moo C� <br /> Signature of Owner o A ent Date y�X <br /> /.�.. . . V <br /> Remarks . .......cler ..................................................................................................................... ...... �n . . m0 <br /> m <br /> a..�-�- ............................................................ . n <br /> ..................................................................................................... .................. <br /> ... .. <br /> t <br /> w <br /> T <br /> Inspection Date fl.- .iii. .......... oaf N �' <br /> Zoning Admi I trator 8 8 8 8 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures n volving sanitary facllitics <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatior test must be attacher) to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any RIL mbing or start any build <br /> Ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the n1 ormation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not he made without approval of [ iv Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />