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Burnett County Office of Zoning Administrator W <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 70 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> O <br /> l...l.!"1.........F.S..h. .. k.`!..................................... ....... rL.rya.. . .°..:.m ... .4 !.../E........................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> —. 7 j <br /> ......�Of-......�a.....lj;.. ....SS/............................. ............................................................................I............... m �1_ r <br /> ADD <br /> /,S�ESS [-` 7 ADDRESS .+ <br /> ........... <br /> �.l f�l' ,.Y.1........_x.t..V....?.32...... ............................................................................................ <br /> ................... . ......... <br /> ADDRESS ADDRESS <br /> PE................................................................................ .PHONE..... :•� <br /> ....... ........................................................................... ' <br /> �- <br /> ILUM .d......� ...................................................... <br /> Pw — <br /> LUMBER WELL DRILLER :�. <br /> N <br /> .............. <br /> ........................................................................................... .............................................................................. <br /> ADDRESS ADDRESS ;W m L) "c <br /> ti o Q_ <br /> ........................................................................................... ............................................................................................ O .i <br /> PHONE PHONE Z N <br /> DESCRIPTIONr <br /> 4. Sanitary Facilities: ° o °» <br /> 1. Work: 2. New Building Details No. Bathrooms Is <br /> New BuildingT No. Bedrooms ..... <br /> .......... Type of Co st}r�ction: :ut ro <br /> Addition rr// Septic Tank Size Gals. <br /> .........0.d.a............................ (� < <br /> y.1:4 6i <br /> Sanitary .��..... Size ...l...l.,... ft. x ....(.'7..... ft. W <br /> FillingHeight 4a. Absorption Field ite: <br /> .......... 9 �...... Stories ...i.�........ <br /> Moving .......... Area .. Soil Type ..... ri...�........ :C r <br /> ......................................... <br /> Grading _ Slope .......................................... �' i o <br /> .......... - ti <br /> Mobile Home .......... 3. Use (describe exactl)�i a "" Perc. Rate ................................... . <br /> Privy ........., home,garage, motel, etc.). Dry Well .......... �� <br /> �,_�L� Seepage Trench .......... <br /> Well L..Q.?.c�`.'...... ?/.;J..�le... -Y.�1.140 <br /> Subdivision Privy j <br /> .................................................... <br /> --------- --- -- ------------ Seepage Bed----- — -- Q L . <br /> �f •N <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 back yard dimension and location and setback from all bodies of water. If property is located at a highway inter <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING fes{ <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ' <br /> ______________________________________________________________________ k o <br /> 5. LQpt Sqe: Fig. A. 6. Location: <br /> I.0.i ..... ft. x . .Q. ft. - s9.ft. ............................................................................... <br /> ............................... m <br /> J <br /> D <br /> C N j" i O <br /> O T <br /> I t <br /> z V, <br /> a <br /> I <br /> !� A c m m o Z <br /> ell30 N a <br /> z oo' <br /> o _ $ <br /> E» � <br /> S <br /> k.. . ... ` .... s -is-�3.... p <br /> lyy�`�•G�. ......... ................ ..... ................................. <br /> Signa uf"re of caner or Agent Date ?V o i C <br /> �7 <br /> x x <br /> Remarks 1. .G...`z�......Ji-:......./...... 7....<<..:�'.......... .... ..�s..�.?�`............................................................ <br /> � Zmt {.. ': fes°. O <br /> ....................... ...`.. ......................................................................................................... <br /> :T u <br /> :O <br /> V > Q o <br /> Inspection Date } � f ° 0 0 0 0 0 on m <br /> ....................................... ................ ....... .....9....... . <br /> ... ...n.�.)....................... : : 000000m <br /> Zonin Ad inistratar o 0 0 0 0 o Cn <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 conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made Without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />