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Burnett County Office of Zoning Administrator V_ o J0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o Lg <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H7 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a f�Al <br /> ...... p.e..sus.................................... ............................................................................................ <br /> OWNER (please prin..Rt)......... /O CONTRACTOR or SURVEYOR or AGENT o. <br /> .1.1..................kJ.. .............. a <br /> : S <br /> ADCD RII ESS ADDRESS 74 <br /> �4 .1e <br /> ADDRESS............................................................................ .ADDRESS............................................................................ <br /> �.5:..:...�1.6. '. 2g. .9..................................... <br /> z. <br /> PHONE PHONE <br /> .......... <br /> ........................................................................................... . . . . . . ............................................................ <br /> PLUMBER WELL DRILLER <br /> t <br /> ADDRESS ADDRESSn o "b <br /> ......................................—.................................................. O ,+ •N <br /> . .......................................................................................... N <br /> PHONE PHONE Z = r <br /> DESCRIPTION 4. Sanitary Facilities: ° n ° <br /> T....... i c� <br /> 1. Work: / 2. New Building Details No. Bathrooms ... o <br /> / <br /> New Building ......•••• Type of Construction: No. Bedrooms .......... <br /> Addition .................................................... Septic Tank Size Gals. ...I...... i <br /> .......... <br /> .......... 1 <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> FiuinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: r� , <br /> Type .................................... <br /> Moving .......... Area ........................................... Soil o <br /> Mobile Home .......... Slope .......................................... <br /> Privy Pere. Rate ................................... i <br /> ,,,,...... 3. Use (describe exactly, 1 �family <br /> Well .......... home,garage, motel,etc.) r Dry Well .......... _ <br /> ,� RPv�t �6r ,2.„., Seepage Trench .......... <br /> Subdivision .......... . ......... . .................... <br /> Camping Unit .......... .................................................... Privy .......... <br /> Seepage Bed I .� <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc., should be sketched in Fig. A. Include 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 inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> P <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: f Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — �...l1c'cto............. sq.ft. <br /> a <br /> m <br /> n <br /> IN O <br /> O = <br /> o <br /> N <br /> 0 <br /> -- o <br /> _ <br /> y ` ” €C7 <br /> Z <br /> All <br /> /6s <br /> /6S 0 <br /> yQ' � t - M <br /> r,® c a m g m <br /> 99 yf rT a < 1° __ _ E <br /> T <br /> �y°rir5� m — m m <br /> J <br /> C <br /> to < ,P •� e = <br /> Z oo n � <br /> _ o = ' a ' 3 <br /> Signature of w r or Agent Date . . — <br /> w SOS 7 : x c <br /> m m <br /> Remarks,e . .............. ........................................................................................................................................... „ : <br /> f» <br /> u <br /> ......................................... ... r <br /> ......................... 1 : �« T <br /> rT <br /> Inspection Date ....................................... .. . ... ..... ...:.............. :�g: <br /> Zoningmimi i� U Adis 8 8 8 8 8 8 <br /> NOTE: A preliminary site inspection must be 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 conveyer] here- <br /> with is found to exist. Changes in plans or specifications shall not tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />