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Bulmett County Office of Zoning Administrator c 1 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H µ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use ,o 'C , <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> n <br /> J s Slyyr — m O <br /> 4 . . ......................��............................................ ............................................................................................ m R <br /> .... .. .... . .. <br /> OWNER (p 'nt) CONTRACTOR or SURVEYOR or AGENT M •.,`cl��.11 ; p <br /> ADOR`p/,(J,� /`Pr.....w.f.`.- STAR Ra..t..... .ADDRESS <br /> .............. .... ... ................................................................................. o- <br /> ESS <br /> n ;d <br /> w a <br /> ADDRESS............................................................................ ADDRESS............................................................................. <br /> PI-y E „ PHONE EVj E <br /> !..R....... .�v.. �1 ASS <br /> .......................................................... . . . ............................................................................... <br /> ...... i <br /> PLUMBER WELL DRILLER <br /> . . .................................................................................. . ..... .. .............................................................................. b O <br /> ADDRESS A..DDR..ES..S <br /> 0o <br /> ........................................................................................... . ....................................................................................... o' <br /> PHONE PH....ONE � Z H r <br /> DESCRIPTION 4. Sanitary Facilities: V o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building Type of Construre No. Bedrooms .......... <br /> Addition �:c....Pjj.............. Septic Tank Size Gals. .......... q W <br /> �Sanitary .,�.,... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: :%4 <br /> Moving .......... Area ........................................... Soil Type .................................... ;-" r <br /> Mobile Home Slope .......................................... c :� c <br /> .......... o' . <br /> Perc. Rate ................................... <br /> Privy ,,,,,,,,,, 3. Use (describe exact) milt' 16 i\ <br /> Well .......... home,garage, motel, etc.) Dry Well .......... F '!p :A1 <br /> Subdivision .......... .................................................... Seepage Trench .......... <br /> h <br /> o <br /> Camping Unit .......... Privy �j V...�1]. <br /> .................................................... Seepage Bed - {C.I'..7.� tf > <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road V � <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 q <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> T ^ O. s <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> :N i <br /> ................ ft. x .............. ft. . ............................... sq. ft. .............................................................................., j :3 <br /> O c <br /> A <br /> N U <br /> 0 <br /> a <br /> o 0 <br /> V ° <br /> f <br /> :o <br /> Z Z <br /> 0 <br /> d <br /> d <br /> Nrv � y Z� <br /> 1Y, s tai fp C W < m o F <br /> m N d c d m <br /> (JI < y c M m <br /> o <br /> � m <br /> Z O iJ l D a <br /> na3 � <br /> t m <br /> m <br /> .... . ..... . -e-r. -o- <br /> ... ............. :................ ...................................... . <br /> Sign ture of 0 ner or Agent Date <br /> ]9� i X <br /> Remarks... .....^....:...`!�.......................................................................................................................... -n m <br /> .............................. .... .... 6 = <br /> q1 II <br /> .............................ff.......................................................... ...................... ... ..`...... ....... ............................................. <br /> Inspection Date ...4�.`.. .`.. ............. ... ..................... i hi °Ni a ii c m <br /> m <br /> Zonin A ministrator 8 8 8 8 8 8 N <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 We made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />