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Anett County Office of Zoning Administrator T0 UUo <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITd 3. 3 \ <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N (p, <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m mom\ <br /> Ordinance, Sanitation Code,and with all other applicable ounty Ordinances and the laws and regulations of the State of Wisconsin. 3 a V <br /> 0 <br /> OWNER (please print) ^ e CONTRACTOR or SURVEYOR or AGENT a <br /> 1..(Q.I.. .o..F►.... ►..........s�......... .a. <br /> ADDR SSj {,/�-G'}1— ADDRESS m <br /> I4 'Sr'. 4i..4 l... ................. .ADDRESS............................................................................ <br /> ... I$.. .. ...... ..... ..... <br /> A/DDR� <br /> PHOt�E.� .."'•". �..(... ........................ .PHONE <br /> ........................................................................................... . .......................................................................................... <br /> PLUMBER WELL DRILLER , <br /> O <br /> ADDRESS <br /> ADDRESS n O <br /> c <br /> O <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° S <br /> No. Bathrooms <br /> 3 <br /> 1. Work: 2. New Building Details "•'••'". o <br /> New Building ,,, ,,,,., Type Of Construction: <br /> No. Bedrooms .......... F i <br /> Septic Tank Size Gals.Addition <br /> Sanitary Size ....�.0... ft. x ...� ... ft. <br /> """"" 4a. Absorption Field Site: <br /> RiIIInglGratling ,,........ Height............. Stories ............... ' <br /> SoilType .................................... <br /> Moving Area ........................................... i r <br /> if o <br /> Mobile Home .......... Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... r <br /> It <br /> Well home,garage, motel, c.) Dry Well • <br /> ec <br /> Seepage a e Trench .......... o <br /> .......... <br /> Subdivision ..J,{.,r.�ii . . Privy <br /> Camping Unit .......... .... ' .. ..40 i <br /> Seepage Bed <br /> ___________ ____Y g -------------------= 4 M <br /> ----------- a N <br /> Location of proposed structures and existing structures,well, sewage systems, roatls,etc., should be sketched in Fig. A. Include road <br /> 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- Q �. ' <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING O < a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---- ------------------------------------------------------------ <br /> 5. <br /> ----- -------------------5. Lot Size: p Fig. A. 6. Location: <br /> .e{,�Q.... ft. x .24c. ft. — .�l ooc)....... sq.ft. ............................................................................... M <br /> r� <br /> N. <br /> n <br /> IN 0 <br /> ND O :C <br /> �\ <br /> j ` o <br /> Nj <br /> r <br /> I6 � o <br /> q0 /o, <br /> iA <br /> O n To O-} e1C ► .�1 q �ecl�. i s .EW <br /> n' Na C : w J S <br /> y : •C Ci <br /> m . m <br /> Z oo n M <br /> o � n <br /> ly o <br /> 0 <br /> �.3 .. �. <br /> m <br /> g t re w r or Agent zuate x <br /> Remarks ....... ............... ........ . ...... ..... ...... .. .... ... .......... ... ... ....... <br /> ............................................................. T <br /> FA <br /> ......................................................................................................... O: : : : : H Tt <br /> O N N m N m <br /> . ......................................... I <br /> Inspection Date <br /> ....................................... .. <br /> Zoning dministrator 8 8 8 8 8 8 rn <br /> NOTE: A preliminary site inspection must be made an 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 Ife made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />