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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3' o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 7 + V <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use 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 /> r• °- iO O <br /> . . ...(,�1.r. ... ....�. ........................ .......................��.. LF ................................ `vf <br /> 6'1 El (please✓Y.pntl CONTRACTOR or SURVEYOR or AGENT <br /> . . ES ..I...................................................................... . .......................................................................................... <br /> ADDR S ADDRESS ::3 <br /> _V <br /> a—is <br /> ADDRESS ADDRESS <br /> \ �t <br /> ?..1., -.. . .6.'..865'7................................. ............................................................................................ <br /> PHONE <br /> ........................................................................................... PHONE.DR................................................................................ ` \ <br /> PLUMBER WELL ILLER <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS aX. <br /> T <br /> 3 <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: , oo 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building .. ... Type of Construction: No. Bedrooms ......... ;D a <br /> :\ \ <br /> 'vim-r-� Septic Tank Size Gals. .......C, <br /> Sanitary ..,?.C7... Size ..3:.`/...... ft. x .46_ ft. /" ".. <br /> ~ <br /> Filling IGrading ,......... Height............. Stories ............... 4a. Absorption Field Site: i '\ <br /> SoilType .................................... r <br /> Moving .......... Area ...../..61.!.f.£,... s{ 0 . <br /> Mobile Home .......... Slope .......................................... :S <br /> Privy .......... 3. Use (describe exact) , 1 -family <br /> Perc. Rate ................................... j— <br /> Well .. .... home,garage, motel, etc. Dry Well .......... <br /> Subdivision Seepage Trench .......... <br /> .......... ..........................................I......... Privy .......... <br /> CampingUnit .......... .................................................... Seepage Bed .......... <br /> ;P <br /> ---------------------------------------------------------------------- <br /> T •c <br /> Location of proposed structures and existing 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. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 <br /> ------------------------ -------------------- __--_—_---_---_--_— v' _ <br /> 5. L t Size: Fig. A. 6. Location: <br /> Im....... ft. x .............. ft. – ............................... sq.ft. ............................................................................... _-. <br /> 4- <br /> N <br /> - <br /> I o <br /> 0 <br /> r- -- <br /> - =�- 0 <br /> l <br /> t <br /> N 17 9 : .y tP Z <br /> m < m E.E <br /> m NO. C� m 5 cm •O <br /> �ofe- G( NeU ss -+ s�slew� 11 �e�(wce tttp zoo ° . 3 <br /> �'Xts�tnt.� SbsfP^✓t 'i�:ur on <br /> o � <br /> L J � m <br /> C�-yy... . ......................................... .......................... <br /> Signature f Owrler Agent L Date / <br /> Remarks ..........�/:5....�5.....1'L......L!!L°w..rv.la��(!'� ......re �4. ... .....a.'v.......�. .....6.......... T <br /> ................ x <br /> rry - eyba�k v2 v Ss u, 7 Wes <br /> ...................rpt.....F.....................fJ .........:..................1 Q................�................Q................................. ; 11 <br /> ��J��i. c,!•.................................................................. .. ................. ......... ......................................... D1J <br /> �i T <br /> Inspection Date ....................................... P m <br /> ... ..... ...............-... ..' ....... .. ........ i d b N ?''°t' o <br /> ZoningAdmi trator 0 8�8I,o <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitins <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 />