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-) 1 (' (�� <br /> Burnett County Office of Zoning Administrator d 7 o f o <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 < N 0 <br /> 1 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CJ's <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 0 i <br /> / g 3 <br /> ......................................... / vf <br /> . . <br /> OW R (please print) GOI R CTO or SURVEYOR or AGENT a <br /> 7......................................... .�.// ..... r �. . /.... �.�?'y....... a <br /> ..J... .YQ�..'�i..... ..s.'�.......... mNk; <br /> ADDRESS ' <br /> .... �.....Za .w/.......syo a.S ..... ................ = - s <br /> ADDRESS ADDRESS <br /> ............ <br /> PHONE................................................................................ 'P–H-0—N,E. ...................... <br /> ........ <br /> ........ <br /> ..... <br /> ......... <br /> ................ <br /> ........................................................................................... . . . ..................................................................................... <br /> PLUMBER WELL DRILLER i <br /> O <br /> .......... <br /> ........................................................................................... .................................................................................. <br /> ADDRESS ADDRESS <br /> n p ; <br /> ........................................................................................... ............................................................................................ 'Z O <br /> PHOE r <br /> PHONE NJ ' <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: M ° o ° <br /> 1. Work: No. Bathrooms ° <br /> 2. New Building Details ••• '• ? <br /> New BuildingNo. Bedrooms .......... a E 7a '�- <br /> .......... Type of Construction: f <br /> Addition .......... <br /> ,,,,,,,,,, Septic Tank Size Gals. T i i <br /> .................................................... <br /> Sanitary .......... Size .............. ft. x ft. " 'R <br /> Rillingl Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> w <br /> Moving .......... Area Soil Type .................................... f: o <br /> Mobile Home .......... ........................................... Slope .......................................... Vt <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... w i <br /> Well home,garage, motel, etc.) Dry Well .......... w <br /> subdivision ./ Seepage Trench .......... o <br /> .......... .................................................... <br /> Camping Unit .,......., Privy .......... <br /> ......................................I............. Seepage Bed <br /> .......... . <br /> ----------------- ------ ---------------- t i <br /> e N <br /> Location of proposed strictures 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. I1 property is located at a highway inter- p a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 4 <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> _______________________________________ __ v ° <br /> 5. Lot Size: Fig. A. 6. Location <br /> ................ ft. xx .............. ft. . ............................... sq.ft. ............................................................................... <br /> �ij <br /> iyi o <br /> �I�1 ,U <br /> W <br /> J znr,� <br /> D <br /> — — Z :\� <br /> - Y O <br /> J <br /> N <br /> r <br /> W m <br /> � _ F <br /> =' m <br /> o ° a = �° <br /> _ m3 <br /> jo <br /> _ m <br /> p <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks . .................................................................................................................................... m <br /> <n <br /> .......................................................................................I.............. <br /> .................................................................................I................... ... ................................ . . <br /> p:U m <br /> yU �/ ' : N N N m <br /> Inspection Date ....................................... �..../.F...�LL ......��.... .. ................. : \:u•t° rn v, 0 8 o U m <br /> Zoning Ad irato � i i \' 8 0 0 0 0 8 0 <br /> 0 0 0 0 <br /> NOTE: A preliminary site inspection inust 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 herr <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 />