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cam'/?C,f3?> 0. <br /> Burnett County Office of Zoning Administrator �/ o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3• 3 `\ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '� p <br /> located as shown herein. The undersigned agrees that all work shall be done in accordanre with the requirements of the ,$ c <br /> Burnett County Land Use Ordinance, Sanitation Code, and wi her applicablitI Coun y rdi nces an the laws and 3 `g <br /> r ati ns of the to of Wisconsi » a <br /> i 15` <br /> , . <br /> P . ... I. �.V1............. . ME' . ........ ............pessa print CON ACTOR orV AGENT <br /> ACJ ?..y........... ha .J.. iV ............... .. .. .. . S ....... .. �. ..aov%e�/................ <br /> A <br /> d11. .........ss. ..... ..... ... .., .....X90........ ........... . 3.. .. <br /> ADDRESS Qal�. AD SS <br /> PHONE PHONE y lo <br /> / <br /> .......... <br /> ........................................................................................... .................................................................................. <br /> PLUMBER WELL DRILLER <br /> v <br /> ADDRESS ADDRESSn o <br /> ........... <br /> ..................................................................r................ .P..H..ONE..... .................................................................... ... •Z N N ✓ , <br /> PHONE r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... e <br /> No. Bedrooms .......... <br /> New Building ,,,,,,, pe o Constr tion: . <br /> Addition Septic Tank Size Gals. .......... <br /> qz w� .................. .. <br /> Sanitary <br /> .......... Size .... ft. x ... ft. .......... . <br /> 1 4a. Absorption Field Site: <br /> Filling/Grading ,......... Height... Q.... tortes ...... .. .. .. <br /> Moving � Soil Type .................................... � r <br /> .......... Area ... �..��....... . ... :. .� � ° <br /> Mobile Home /........ Slope .......................................... » <br /> .. <br /> Privy 3. Use a ri exactly,'1 -family Perc. Rate ................................... d <br /> Well h a agtel, etc.) Dry Well .......... j , <br /> Seepage Trench o f,/V <br /> Subdivision py,�•„ ... .......... . <br /> Camping Unit Privy .......... <br /> Seepage Bed .......... <br /> ———— -------- -------- ------ ' in <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at O <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Q F0 <br /> --------------------------------------------------- <br /> __ ___ 1 <br /> 5. Lot Size: Fig. A. 6. ation: //-- <br /> E0....... ft. x .`� . ft. — 3QQ........ sq.ft. 1V15. 7!^1 ........f-G4 ,, ........ <br /> 1 lI� <br /> N O <br /> O ° <br /> J 0 0 <br /> 1 WE <br /> 02� <br /> J� Sano NZ01 o <br /> t <br /> ' Z <br /> pu(r)l Jaloz r <br /> )i-I, <br /> 4101 c oNi m n _c cm '9 <br /> \ / H <br /> I /'^)�/ a Nn `c 0 c:0 as9 <br /> { bp� ) K 9 m 3 <br /> o c m <br /> m ' C <br /> c 1mFa <br /> � <br /> ..�1 gal .... cEs�'( <br /> Qignatu'r� Owner or nt Date $ <br /> .. ....... . . .... \... ... ...1.�.�......... V <br /> Remark ..�....... .. . . . .1rt!�...........� � � � _ <br /> . .. . . �.........0 ......... N�•• N <br /> ........... ... <br /> ........................................................ r N <br /> O ' ' <br /> .. ...................................................................................................... .... .................. .......................... .................. : O <br /> Inspection Date ....................................... �_'. I—.... � i 1�........ 8 8 9 8 ai <br /> Zoning Admini r for <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />