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But Ilett County Office of Zoning Administ for 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 describe and p <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements f the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the law and 3 <br /> re ulationsof the Stateof Wisconsin. <br /> ..................................... . . . .... ........ E?Q <br /> OWNER (please pfim) CONTRACTOR or SURVEYOR or, AGENT <br /> .......................................... ................................................................... . n <br /> 4 .k?.. a...�..: - <br /> A DRESS ADDRESS <br /> - : <br /> A DRESS ADDRESS f� <br /> ........................................................................................... . ................................................................................. ........ \ J <br /> PHONE PHONE <br /> ........................................................................................... . . . ............................................................................ ........ <br /> PLUMBER WELLDRILLER <br /> ADDRESS ADDRESS <br /> n o <br /> o <br /> ........................................................................................... <br /> . ..... ........................................................................ ......... <br /> PHONE PHONE.. .. Z „ r <br /> DESCRIPTION 4. Sanitary Facilities: c ° <br /> 1. Work: 2. New Building Details No. Bathrooms ...... <br /> New Building ., Type ofnstructi No. Bedrooms ......... <br /> Addition ,-,,, Septic Tank Size Gals. ......... <br /> .......... ....... .... ... <br /> Sanitary .......... Size ..5.-'�.�. ... ft. x ...” ft. ......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> SoilType .......................... ......... r <br /> Moving .......... Area ........................................... o <br /> Mobile Home .......... Slope ................................ ......... <br /> Privy Perc. Rate ......................... ......... m - <br /> ....... 3. Use (describe exactly, 1 -family <br /> Well .......... home,garage, motel,etc.) Dry Well ......... E E.(-- <br /> Subdivision .......... Seepage Trench Z <br /> .......... .. Privy <br /> Camping Unit ,,,� ". <br /> Seepage Bed ......... : 1 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in ig. A. FL <br /> 0 r <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loc ted at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the interse tion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. C-3 o' <br /> _______________________________ J <br /> 5. Lot Size: Fig. A. 6. Location: „ <br /> ................ ft. x .............. ft. . ............................... sq.ft. .................................................................... .......... <br /> r ;R <br /> N — <br /> O <br /> nO f� <br /> Iry6 » $ <br /> J <br /> i <br /> a <br /> 1 T +yam <br /> T <br /> O <br /> a <br /> m <br /> F <br /> m e m r ncool <br /> o �o' m <br /> m Na�c — nm any <br /> a O< d C <br /> O„ c <br /> 0MCI <br /> ';2 D 1 <br /> yn ' <br /> O O <br /> m <br /> Cr,"�w'x.............................. .. .... .... .. . ... ........... <br /> Signature of Owner or Agent ate 8 <br /> m: <br /> Remarks .......... ... ........ . ......................... .... ... ..................... .......................................................................... ........ <br /> AJ.G: :... N�.LY.:?. . .... 'fd11.1.1.(.1:.. .'n�..` `—. ..................................................... ......_ <br /> ......................... o . <br /> 8 <br /> "ry O <br /> Inspection Date ....................................... ?Ig <br /> .. . .. .�..:....y'lCf:...... m v, u, o o v, <br /> Zoning Administ a r 8 88 8 8t <br /> NOTE: A preliminary site inspection must be made and site approanted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this al iplication before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has b en issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans Dr specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND PPROVED. <br />