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Burnett County � ` 4 Office of Zoning Administratord 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THF ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N •t\ <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 c- <br /> :O <br /> a <br /> ..... _ m O <br /> .. ,..�� 2 <br /> ..... r/..................................... ............................................................................................ N <br /> OWNER (please pri t) ` CONTRACTOR or SURVEYOR or AGENT a <br /> ...........� ...�L�4j�.....1 UQ�/..... .. . . . ............................................................................ <br /> ADDRE .................. ...D . . . . <br /> d()12 5�g3c� ADDRESS 1.* <br /> .. . . ....5 ............................. . .......................................................................................... C�i� TJ <br /> 7 <br /> .. . . ........................... ..... ...... <br /> ADDRESS _ ADDRESS <br /> 5�.:...7�......./..................I........ <br /> 0 <br /> PH PHONE <br /> ......... ........�............................................ ........ ..... ........... . ...... ............. ................................................... o_ P <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS .4 <br /> O i <br /> : <br /> ........................................................................................... fpc ^f- ,Ora :� �* <br /> PHONE PHONE z H <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building .....A""..... Type of Construction: No. Bedrooms <br /> Addition Septic Tank Size Gals. <br /> Sanitary Size ...�Z...y ft. x ... . .. ft. ..—.....r te <br /> 2 / 4a. Absorption Field Site: <br /> FillinglGrading .......... Height. .......... Stork ..... P <br /> Moving .......... Area .......1.,.�..O(�.....�................ Soil Type .................................... •o <br /> all <br /> Mobile Home Slope .......................................... 0 <br /> .......... <br /> erc. ate ................................... i <br /> Privy 3. Use (describe exactly, 1 -family �PR4 <br /> Well „/ihome garage, tnotel, etc.) Dry Well .......... <br /> Subdivision � 'Lfi Seepage Trench .......... <br /> .......................... <br /> Camping Unit Privy .......... y` <br /> .................................................... <br /> Seepage Bed <br /> ------------------- — <br /> — ------------- — — <br /> --- -- — --- -- � <br /> �- 91 <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be, sketched in Fig. A. Include road it <br /> setback, side and backg y <br /> yard dimension and location and setback from all bodies of water. It 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 :a p' <br /> ----------------------------------------------------------------------- <br /> E <br /> 5. Lot Si e: i Fig. A. 6. Location: <br /> �1 <br /> /6 .... <br /> ft. x ....%! I. ft. — ...�.J.:�..�/�5..... s9.ft. �..3b. .S .... G... ... ?.S-.Y..�.-10 <br /> j. <br /> cjA1tV �l Zis� , q ON <br /> 0 <br /> a <br /> i <br /> s" <br /> _ .4 <br /> 1 n�/ 7N�uApSm.+ Rd D/�*y " <br /> 6 77 Vlry mmZ <br /> -4gi III <br /> m . m <br /> Z 0 no <br /> o = a� 3 <br /> a <br /> ... <br /> .. ............. <br /> v, ' C <br /> Si n lure caner or A en <br /> 0 <br /> Sig' 0 g t � I Dat <br /> Remarks ..!O(.��... � �'LA ' T� m <br /> X 77 <br /> m <br /> ..................................::..I�dj r........&d.....st.�b�c�.......t�/�P....... <br /> ` G/�rl ole.......................... <br /> -.. -. ..y............. .. ... ... .......... . .. ....................................................... II <br /> Inspection Date . r-1UF' . . : o $N <br /> MM" <br /> ... . ... . A . ............................... $ V1ding dministrator <br /> NOTE: A preliminary site Inspection must 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 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 INSPECFED BY THIS OFFICE AND APPROVED. <br />