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Burnett County Office of Zoning Administ hator o <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 '< — <br /> shown herein. The undersigned agrees that all work shall redone in accordance with the requirements of the Burnett County Lad Use m C <br /> Ordinance, Sanitation Code, and with all other applicable/County Ordinances and the laws and regulations of the State of Wisi onsin. 3 M <br /> ......... .6.CAJ!✓E.GI� .� .4........ ........M:€;./Vale-C�...,5 .... . .. \ o`l <br /> W R (pi se print) CONT CTOR or SURVEYOR or AGENT, <br /> a <br /> y / <br /> 1 ..d........ .�. ... ...........� c7 K S o ry i A! & . <br /> ................. ........ ...........!.V 1..................... ......... <br /> ADDRESS _ ADDRESS °1 <br /> ADDRESS .u.2.y........ ....... .........)i...... ..k.—. <br /> W( I ( ' <br /> ...... ......... :Sli <br /> _ ADDRESS <br /> ..1...�....`.... ..s...�........ o / U <br /> PHONE ................................ . ................................................................................ ......... <br /> PHONE <br /> PLUMBER .WEL...........RI.....LL... ........................................................... ......... <br /> L DER.. <br /> ......................................................................................... . <br /> .. .O <br /> ADDRESS ................................................................................ ......... <br /> ADDRESS U <br /> n p 'o <br /> < s <br /> PHONEPHON..E...................................................................... ......... <br /> DESCRIPTION 4. Sanitary Facilities: P o <br /> 1. Work: No. Bathrooms ' <br /> 2. New Building Details ••.••.... <br /> o <br /> New Building .......... T e of Constr ction: No. Bedrooms ......... o <br /> m <br /> Addition .......... ... ..gt..( ,V....... ...d:2...n�......._.... Septic Tank Size Gals. ......... <br /> Sanitary .......... Size ........ ft. x ......d S. ft. ......... :lam <br /> Filling/Grading .......... Height.../..Q...p. Stories ......A....... 4a. Absorption Field Site: <br /> +'�� <br /> Moving .......... Area .........�.X.0 Soil Type .......................... ......... :tib <br /> Mobile Home .......... Slope ................................ ......... iO o <br /> .. ; <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ......................... ......... <br /> Well .......... home,garage, motel, etc.) Dry Well .......,. <br /> Subtlivision Seepage Trench ......... <br /> .....a.YT............ . .....vv!....... <br /> Camping Unit .......... /. Y ......... <br /> ............................... <br /> — <br /> Seepage Bed ......... :Ill <br /> --------------------------------- --- m <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Inclon road C ?� <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwa n <br /> inter- I <br /> section, show the intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXI TING <br /> o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :V,, o <br /> ________________________ <br /> 5. Lot Size: ot-3, 85— 1V L, S --- <br /> Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. .......... :O <br /> y <br /> ul m <br /> n N 0� o <br /> p <br /> ER G 0 <br /> L <br /> YJ�e ja SE d r �(' 1 <br /> 6 Xv T <br /> ♦p <br /> yO 3' Z <br /> P <br /> �cglr <br /> DAA# n1 <br /> trM <br /> .7 F0r E-11S ,n�q <br /> � 1 <br /> d <d < <br /> Ifc1 rD N O, c: d W <br /> un <br /> / m <br /> tt_ Z 0 <br /> 0 n <br /> ® J () O n m <br /> `_- <br /> WeLL / <br /> 41cc, <br /> Pill <br /> Ignature of caner or Agent Date <br /> �o c <br /> X M <br /> Remarks ................................................................................................................................................................... ..... m m <br /> v <br /> SU.'I <br /> ........ ..................................... ..... <br /> ''MM <br /> Inspection Date ....................................... $ o m <br /> ?site <br /> ..... .. .......... ..................................... ..... <br /> Zong dm in istratorNOTE: A preliminary site inspection must be made aproval 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 pin nbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the inf rmation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of ti e Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />