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�c"�Ilf <br /> Burnett County Office of Zoning Administrator d o 00 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d �. <br /> TO THE ZONING ADM IN I STRATOR. The undersigned hereby makes application for a Permit for the work described and looted as < H �\ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use 7 v^ <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis onset. 3 <br /> O� <br /> ► ....... .. ..n.e4.. �...................... ........ . . ....................................................... ......... o <br /> I .. <br /> ER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> ....... . . . <br /> PIZ- <br /> d <br /> ADDRESS ADDRESS <br /> ......... ........` . . i. 3..... ................................................................................. .......... <br /> ADDRESS ADDRESS 0 <br /> .........SSC..:..` ........................................... ................................................................................. .......... <br /> PHONE PHONE <br /> ..�.. ........................... .................................. ....................o..�.�............................. <br /> PLUMBER WELL DRILLER <br /> .. ...................................................................................... ..... <br /> ............................................................................ .......... p <br /> ADDRESS ADDRESS m G) <br /> e <br /> n, o <br /> ............... . ...................................................................... ................................................................................. .......... o <br /> PHONE PHONE Z 0 <br /> DESCRIPTION 4. Sanitary Facilities: �J q ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building ,,,�, Type of CgQnstruction: No. Bedrooms <br /> Addition n1, , t h,�; Septic Tank Size Gals. / .(.'.. <br /> . .......................... < <br /> Sanitary .......... Size .....a�.y... ft. x ....�,.7... ft. <br /> Filling/Grading .......... Height.1'vl4t Stories .... .......... 4a. Absorption Field Site: <br /> Moving .......... Area ......................................... Soil Type .....................?z!� x....... E i m iE <br /> o <br /> Mobile Home Slope ............................... .......... <br /> Privy ,......... 3. Use (describe exactly, 1 -family Perc. Rate ........................ .......... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... �( �y{ <br /> Subdivision GCL Seepage Trench .......... �l <br /> Camping Unit .......... ...............J. ............................... Privy ........ (ti <br /> ------------------------ Seepage Bed------- -- <br /> Location of proposed structures and existing structures,well, sewage systems, roads, eta, should be sketched in Fig. A. Indu le road Q. <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highway iwer a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX STING I ,�— iG� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> -----------------_.__.-----------______—__---_------------------_--- E <br /> 5. Lot Size: n, Fig. A. 6. Location: <br /> ...lOn Sy (� ai g.ft. ''// `.. ... ...`........... ns..t.t.p.. .`.LU.. of� � s <br /> ........... ft. x .. ....,... ft. — ...... .. 4V t..7......5... 4 .'S c .. <br /> s Pet ncif 15 we`,� - (7ju Rlle4f OO . <br /> c y , Sk <br /> J <br /> o <br /> ° � o <br /> 0 Z <br /> 0 <br /> sa <br /> av,7 <br /> n�zi ytr p� ' <br /> f y, <br /> J � CS � 6OS <br /> ijot Na. p' F <br /> T` yceR <br /> Z Oa <br /> a � 7 <br /> � fn <br /> ttt o <br /> Il.'L'tT S u ojO <br /> R <br /> g n a t u r e of Owner or Agent p� Date <br /> X 3 <br /> m <br /> Remarks ................................................................................................................................................................ ........ 7.� � <br /> m <br /> » ' <br /> ............................................................................................................ ..... ................... ........ .................... ........ <br /> Inspection Date ....... .......... ................. .. u <br /> Zonin Admini ator l� 8 0 0 0 0 <br /> NOTE: A preliminary site inspection must be mad site approval granted on all structures nvolving sanitary taciliti .s <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 ir formation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />