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07'1 L.Lb � <br /> Burnett County Office of Zoning Administrator at, <br /> -H0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- <br /> » <br /> ........................................ <br /> ....Q. .............. .......... ?i..vl..r.. ................... ............................................. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> o F / L � .. , <br /> ADDRESS ADDRESS <br />....S...r.........PQ. ...C..... �,..ft............... -s�j...� .......................................................... ................................. <br /> ADDRESS ADDRESS <br /> ............................. ..................................................... . .......................................................................................... <br /> ' � b <br /> PHO PHONE ;S <br /> ................................................................... <br />.... ................. ............................................................. .WELL <br /> PLUMBER <br /> ................. i�\ O <br /> ADDRESS ADDRESS n o <br />........................................................................................... . .................................................v....................................... <br /> PHONE PHONE 2 r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> No. Bathrooms .. <br /> 1. Work: 2. New Building Details """"" �'�p o S <br /> New Building ...x... Type of nstruction: No. Bedrooms ...�. .... <br /> Addition PA „M '� Septic Tank Size Gals. .......... � Z i <br /> ...... ... ............ ................................... .. <br /> Sanitary ..AS.... Size ..a&a..... ft. x .... ft. <br /> 4a. Absorption Field Site: y ' <br /> Filling/Grading .......... Height............. Stories ............... •T <br /> ........ Soil Type .................................... : r <br /> Moving .......... Area .......................Q........... ;[' o <br /> Mobile Home r7� X 3 !-' Slope .ate .................................... � <br /> .......... :h <br /> Privy .......... 3. Use (describe exactly 1 fami Perc. Rate ................................... <br /> Well ,.x... home,garage, motel, etc. Dry Well <br /> Seepage Trench .......... lo1 <br /> Subdivision ,,......,, <br /> ........................... Privyaj i4& <br /> --Camping Unit— <br /> .......... .............................I..............I....... Seepage Bed a1 <br /> /.--- b w .G <br /> Location of proposed structures and existing structures,well sewage systems, roads etc., should be sketched in Fig A. Include road � 'ry a [ <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- L; iry °C <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING :r vl <br /> vl <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --------------------------------------- — ----------------5. Lot Size: Fig. A. 6. Location: C . <br /> ................ ft. x .............. ft. — ............................... sq.ft. ..............................Y..!. , <br /> .,........5.... .................... .� <br /> 0 <br /> ti <br /> N o <br /> D 7 <br /> O ` <br /> 0 <br /> O YV <br /> 0 <br /> O <br /> J <br /> S <br /> 9.0 <br /> Z <br /> 0 <br /> O� <br /> n <br /> M to CL 'a m B' a F 1 <br /> �. N . m � OJ <br /> G G m <br /> b 5. m n <br /> Z O o a n � <br /> EA » <br /> o <br /> O : <br /> 0 <br /> ........ .�.............................. ... .... ..... o C <br /> Sigre o�f/'¢,w/ner or i Date �.X <br /> m <br /> RemarksL' :...1.1....�L.:[;...C�.' `.'....................................................................................................................... <br /> c» <br /> ...........................................................`........................................... ... .......... ....... . m <br /> - 1 Uo � m <br /> yy yy11oo ... . <br /> Inspection Date Li,.. .L.... ..�............. ... ..... .....�...%.fF�n... .... . ...................... v, o m <br /> p . .....Zoning Admi Ist,'( rator y�J 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 facilltius <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 />