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Burnett County Office of Zoning Administrator on o " O <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> } <br /> o <br /> TO THE ZONING ADMINISTRA?OR'. The undersigned hereby makes application for a Permit for the work described and looted as <br /> N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County La d Use e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis onsin_ `0ann <br /> , . <br /> h °rlqh .. . � r.pl4....h.r....y.oKe.6..... ........................................... ............. ....................... ......... <br /> OWN ease <br /> pant) CONTRACTORor SURVEYOR or AGENT m <br /> ,p _ <br /> ll..�.:.�......' �..Q..7�.. .q.J .................................. . . . . .............................................................. ................... a <br /> ADDRESS ADDRESS <br /> P-11 <br /> ADDRESS ADDRESS <br /> ........................................................................................... '; <br /> �76 a / PHONE <br /> r - 6s��- <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... <br /> O <br /> ADDRESS . .................................................................................... <br /> ADD......RESS c) o I _ <br /> < Vt <br /> ........................................................................................... .P..H..O....................................................................................... o <br /> PHONE NE z N ' <br /> DESCRIPTIONr <br /> 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms ...1..... <br /> o <br /> New Building .......... Type of Construction: No. Bedrooms ..�..... A <br /> Addition .... ...................................o.(.�..(......... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ...l.�f..... ft. x ..oF.or.•. ft. <br /> Rillingf Grading .......... Height............. Stories ..../......... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type ......................... .......... <br /> MobileHome ........................................... Slope ............................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................ .......... <br /> Well ...I...... home,garage motel, etc.I Dry Well .......... <br /> Subdivision .......... .A ' Seepage Trench .......... t 1 A <br /> tN....................... ]Tf* <br /> Camping Unit ...... Privy .......... 'f� <br /> .................................................... <br /> -------------------------------------------------- Seepage Bed--------- --- Q` <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched In F,g. A. Inclu e road e <br /> setback, side and back yard dimension and location and setback atom all m and at water_ If property is located at a hlghwa Inter <br /> section, show the intersecting highways and the setbacks required along them and at the 'intersection. CLEARLY LABEL EXI TING fV,i(RyU 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS---------------------------------------------------------------. <br /> 0 <br /> 5. Lot Size: Fig. A. 6. Location: Q ' <br /> ../.CJ.lP... ft. x .hJ 1��.Q. ft. — ............................... sq.ft. 1 i i <br /> T �- <br /> N o. <br /> o � <br /> 5 <br /> Af <br /> .> s <br /> IS�cTib� SSC-nod I �l 1 y` <br /> ---��'----�i 130 <br /> llF�� <br /> ca <: „ a I¢ <br /> Z 00 <br /> o —= n <br /> _ inSII <br /> . ............... , ill <br /> l / o A <br /> :�t o ne o. . A .. ... ......... .................. .. . \l s c <br /> Sire r <br /> gnag Date 4,- — <br /> A 1P He, <br /> Remarks ......................................................................................................................................................................... T m <br /> v <br /> d <br /> f „ <br /> Inspection Date .......... .. . ...... ..... .. .. . - (C�rl.i, 'ti.' � �� 1 ���41�. �t} � p roal o m <br /> Zoning Administrator8 0 0 0 N <br /> NOTE. A preliminary site inspection must be made and site approval granted on all structures ii volving sanitary facil itus <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatlo test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plc Itching or start any build <br /> Ing until a permit has been issued. A permit may be revoked If misrepresentation of any of the in ormation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of t�e Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE IAND APPROVED. <br />