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Burnett County Office of Zoning Administr for g <br /> APPLICATk �R SANITARY — LAND USE — BUILDING PERMIT 3 3 <br /> TO THE ZONING ADMINIo i HATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the m e <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations 1of the State of Wisconsin. <br /> d <br /> .. .G....................................... ... ........ SURVEY...:........................................ ....... <br /> OWNER (plesae,pgri't) CONTRACTOR or SURVEYOR OR or AGENT <br /> r. ?....XT ..Y....���Pt.. r-............. .................................................................................... ....... a <br /> ADDRESS ADDRESS <br /> ADDRESS ADDRESS <br /> . . ... ....... <br /> ................................................................................ .P....HO...NE.................................................................... . . . E� <br /> PHONE <br /> ................................................................... . . . ..................................................................................... . <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS n O <br /> •••••••••••................................................................................ .PHONE.................................................................................. ........ N <br /> 'Z w , <br /> PHONE <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> ' "th <br /> Barooms v <br /> 1. Work: 2. New Building Details No. i o <br /> No. Bedrooms <br /> New Building ,,,,,,,,, Type of Construction: <br /> Addition '�,?COQ Septic Tank Size Gals. <br /> .. ...... ........ <br /> Sanitary Size ..3.:k.... ft. x ....1.1..... ft. . ........ <br /> Fnlingloreding .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ........................... ........ o i <br /> Mobile HomeSlope ................................. ........ ., <br /> .......... <br /> Perc. Rate .......................... ........ i <br /> Privy .......... 3. Use (describe exact) '1 •family o' <br /> a <br /> Well ho e,garage, motel a Dry Well . ........ m <br /> Subdivision Seepage Trench . ........ o <br /> .. ....... {I.-.. .......... ..... ........ <br /> Camping Unit ... d,l: ;- ,.- Privy . ........ �. i i <br /> .......... Seepage Bed . ........ ' (� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in F g. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca led at _ <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ___ 0 <br /> --------------------------------------------------________________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> tl <br /> ................ ft. x .............. ft. . ............................... sq.ft. ........ t <br /> N O <br /> Yyc L 0 <br /> f <br /> _ _T <br /> /y1J' T <br /> �\�2tk ate' ° <br /> S AK a <br /> J� 0 -a m r D W co <br /> rn <br /> �yZ trt.TF !7l fCT''•�� ,r, m_ �a< '- n m n n 9 <br /> � aor a o�' <br /> oino `.° •2 n -4 <br /> C4 n ; y <br /> 0 2m <br /> " 0 O <br /> a o m <br /> In <br /> .. ..... Q... .P2 x <br /> Signature of Owner or Agent Date 1 $ <br /> N <br /> T . <br /> Remarks .................................................................................................................................................................. ...... m`. <br /> N <br /> ................................................................................................................................................................................. ...... O <br /> O <br /> ....................................................................................................... .... ..................... .�............................ .... <br /> Inspection Date ....................................... .... !..lM`. .... . ...... N N N O O r <br /> Zoning Adminis ra or S 8 g � I <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f icilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this apl lication 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 o specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANDA PROVED. <br />