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Burned County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as c <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use �\ <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 3 a <br /> m <br /> O <br /> N <br /> 1, ..R.hr...... .:.....5 r - <br /> OWNER (please print) �.• CONTRACTOR or SURVEYOR or AGENT <br /> '�rlQq .1.:t� <br /> .................................................... <br /> .......� <br /> ...... a <br /> ADDRESS n IC m ADDRESS m <br /> ...................................................... <br /> A .E .. ........ <br /> ...... <br /> ,............. <br /> .............. .. ......... . .................................... <br /> ADDRESS <br /> �° <br /> PHONE <br /> . . ..................................................................................... <br /> ......................... . <br /> .................................................................. WELL DRILLER ( .. <br /> PLUMBER <br /> O <br /> � ' <br /> ..... . . . ............................................................................... . .......................................................................................... m L1 <br /> ADDRESS ADDRESS = ° <br /> _ < <br /> ................................................... . .......................................................................................... .i <br /> o <br /> PHONE O 17 <br /> 0 <br /> PHONE ' <br /> DESCRIPTION 4. Sanitary Facilities: 0 <br /> No. Bathrooms .......... •9 ~ <br /> 1. Work: 2. New Building Details ` ° <br /> � y Type of Constru Ion: No. Bedrooms $ "\ ! �� <br /> New Building ...V A r Septic Tank Size Gals. .......... <br /> Addition ..SCyet ..... Q. . iy_ <br /> Sanitary .......... Size 1la..p.al:,. ft. x .............. ft: 4a. Absorption Field Site: <br /> FillinglGrading .......... Height....A....... Stories ....�........ . <br /> SoilType .................................... 0 <br /> Moving Area ........................................... Slope ................................. ........ <br /> ry <br /> Mobile Home .......... Perc. Rate ................................... _. <br /> Privy .......... 3. Use (describe exactly, 1 -family Dry Well <br /> Wellhome,garage, motel, etc.) <br /> Seepage Trench .......... <br /> Subdivision .......... .................................................... Privy r <br /> Camping unit .......... .................................................... Seepage Bed <br /> ^. : <br /> ___________________ __________________________________________________ <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 /> a_. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ----------------------------------------— —---- ---------------------- <br /> I <br /> 5. Lot Size: -f- Fig. A. 6. Location: <br /> ...I.U..ID..... ft. x —26-D ... ft. . ............................. . sq.it. ...........................................\.................................. <br /> f� <br /> .(..O$ N <br /> O <br /> 3_ <br /> 7 <br /> 0 <br /> y1V(1-5i T`. d <br /> : <br /> s"A <br /> f.w.., rnrv � m W <br /> t YI 1`en^ lam l N. n�a c m m <br /> a rr < m .� n E <br /> " O rl <br /> Z o 0 0 I n7 <br /> am Z <br /> S�q,ov�2 r "C r <br /> ' natureofwneror gent Date w`A"A" i <br /> X � <br /> ........... <br /> Remarks .............................................................................................................................................................. <br /> .................................................................. <br /> ............. O <br /> 0. U tNT O O N l <br /> Inspection Date ....................................... �: 8 8 $ 8 $ 8 <br /> ................. <br /> . . OZoni Administrator <br /> NOTE: A preliminary site inspection must be made a d 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 builel <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 tie made without approval of the Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />