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Burnett County Office of Zoning Administrator c 7 0 0 <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 H O <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e I <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> 'a _V <br /> ..... . . d O <br /> (1.Tr..T ..... 7......... . ? ^ .. .......................... . .......5?4. ....... ...�............................................................ <br /> A <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m '^ <br /> ADDRESS.. 05... n.7 ..:<q<�.................... ............................................................................................ <br /> n <br /> ADDRESS •-. <br /> p1eDq�. ..yr�.......S 7/f........... <br /> . ......................................................................................... <br /> ADDRESS . <br /> ADDRESS <br /> ........................................................................................... t !`�. <br /> PHO PHONE <br /> .................................. <br /> �T........... <br /> PLUMBER ` . ..........................................................................4............... O <br /> WELL DRILLER <br /> D!' R ..C ^1 ..................................4............. . .................... <br /> ................................................................... <br /> ADDRESS ....... .. . ... — <br /> ADDRESS LD? <br /> .......... y—...3.-a. .................................................. �?051.rcgn.�r.. - bra.,................................ o <br /> PHONE <br /> Z <br /> r <br /> DESCRIPTION 4, Sanitary Facilities: P o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .....I.... <br /> New Building <br /> .,,n... Type of Construction: No. Bedrooms ... .. ; �° <br /> Addition ..., U�9B1)....��.�?rLH�t Septic Tank Size Gals. .7.S.0 <br /> Sanitary ...X.... Size ...w2.0.... ft. x ...A4.. .. ft. (.��` <br /> Filling/Grading <br /> .......... Height........... Stories .....1........ 4a. Absorption Field Site: p,\ <br /> Moving .......... Area ...... .....7Z.f ..................... Soil Type ....... <br /> 2 <br /> a............................ <br /> o <br /> Mobile Home Slope .................../f....... ' <br /> .� <br /> Privy ...... 3. Use (describe exactly, 1 -family Pere. Rate ............ ................. . <br /> Well Dry Well .......... <br /> .,�(.... h...°—mel garage, motel, etc.) <br /> Subdivision .......... Seepage Trench .......... i <br /> Camping Unit .......... .................................................... Privy ( <br /> SeepageBed---------------------------------------------------------------------- <br /> Location of proposed structures and ertisting 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. CLEAR LV LABEL EXISTING Ui <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. t ' 'j <br /> ---------------------------------------------------------------------- � <br /> 5. Lot Size: 7/ Fig. A. 6. Location: <br /> ,360.... ft. x ../O.d... ft. — ....!(?y �OQ............ sq.ft. ......L. A%�A�.:.. #07 lliI........................... 4 1 <br /> m <br /> n <br /> N O <br /> O ] <br /> O ]' <br /> � Y <br /> �l 7 <br /> t S <br /> T <br /> Z <br /> v <br /> M Ni no .0 W Z <br /> at w = m <br /> n Q c < m E' F <br /> m Na � � n to <br /> a tft < ,� m c 'O <br /> Z o o y a T <br /> FA '_ <br /> �� y, o� m <br /> ......................... .. .... ...... .........(�..........�..... <br /> _ C <br /> ? : <br /> ..... ...... o C <br /> Signature of Owner or Agent Date <br /> .... .... .. x <br /> Remarks1 m <br /> m <br /> /L�c' C i[.... ... <br /> ..... / CICZ �" Cr .,-CGT/'�L G.<% X <br /> C................................... .................................................... ................ ....gd6l <br /> //// l n Nm <br /> Inspection Date .(.G(.......:5............. ...... i%�//�� �..l. o a o N o N <br /> ... ................. o 0 0 o m <br /> Zoninstrator 0 0 0 $ o $ y <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 />