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Burnett County Office of Zoning Administrator <br /> o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <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 be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code,/and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. re <br /> 3 re :O <br /> Ll.!�.!1........ N . ................................................... ............................................................... _ <br /> n <br /> K <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT :� Q, <br /> ^T�' n a <br /> ... ..` W........... .. .................................................... . ..... . .............................................................................. <br /> ADDRESS d O <br /> ADDRESS ` <br /> / <br /> `. bST....... w........................................... <br /> ADDRESS ADDRESS <br /> ........................................................................................... ............................................................................................ <br /> PHQNE .. ....................................................... PHONE i <br /> ....`t`)....� .P.....'... .(Wf 'WE'L' ..L..DR....I..LLER........................................................................... :4 <br /> PLUMBER iA+ :r{ <br /> O <br /> is <br /> iJ\ <br /> ADDRESS ADDRESS i� 0 O :Q <br /> ........................................................................................... ............................................................................................ <br /> PHONE PHONE Z H <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> i. Work: 2. New Building Details No. Bathrooms .. :6', o <br /> No. Bedrooms .�-... `21 <br /> i <br /> New Building .......... Type of CoQstr ction: " ;°Q m <br /> Addition .-0...;� Septic Tank Size Gals. <br /> .l.k. .......... < <br /> Sanitary x?„ Size ft. x� ft. •�'�'V \ <br /> Fillingr Grading .......... Height............. Stories ............... 4a. Absorption Field Site: 1 <br /> Moving Soil Type .................................... �7 <br /> .......... Area ........................................... o <br /> Mobile Home Slope .......................................... 0 <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... N <br /> Well home,garage, motel, etc.) Dry Well .......... 5) <br /> .......... `-I i <br /> Subdivision Seepage Trench .......... <br /> Camping Unit .......... .................................................... Privy .� <br /> .................................................... Seepage Bed <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 hack yard dimension and location and setback from all bodies of water. If property is located at a highway inter- _o- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection- CLEARLY LABEL EXISTING <br /> �a A <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i 5' <br /> q <br /> 5. Lot Size: Fig. A. 6. Location: :f <br /> ................ ft. x .............. ft. — ............................... s9. ft. � .i <br /> a <br /> N � O <br /> O <br /> nn rr � r{I <br /> CCl7��� ✓ o , a �� <br /> D <br /> z <br /> / 1 r <br /> I l N r v :E pro Z <br /> a c m M <br /> Z o o y n m <br /> O a ]0 <br /> v <br /> � o <br /> r \ rn <br /> �.. /� -LO - 4'f C � m <br /> T <br /> Signature oner or Agent Date <br /> y„ X <br /> a :d Lt e� T m <br /> Remarks ........ .. .. .. .... .......................................................................................................................................... .� � � � <br /> ...........`ff .... r - <br /> ............................................................. <br /> /n ,............................................ ........ � 11 <br /> ...../ ................................... ............................................................................ <br /> O / <br /> Inspection Date . ....Jo / ..eh" yArGtJ................. lo: o o m <br /> ....................................... .. ........ .................•..... ............ m <br /> Zoning Adrn rotor /c d 8 0 0 8 8 8 V7 <br /> NOTE. A preliminary site inspection must tie 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 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 information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not Me made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />