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Burnett County Office of Zoning Administrator �' c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITd 3 ^} (J <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and >•-- <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the -� <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. —' — <br /> FO ....ULc._I/— ),11 r Kr L:c !L y" <br /> i d <br /> OWNER (please print) CONTRACTOR orgbRF�T�R'8rM9EMT .°, <br /> rt n <br /> ..... . . . ............................................................................... . ...... ... ................:.. ......................................................... <br /> ADDRESS ADDRESS <br /> 'HCl <br /> ADDRESS ADDRESS <br /> PHONE — (lO S ,� t �,,�4, PHONE <br /> -Ki< <br /> .......... s <br /> PLUMBER WELL DRI LLER _ <br /> O <br /> .......... <br /> ........................................................................................... .ADDRES.. .... ... .... .................................................................... _. <br /> ADDRESS S <br /> n O <br /> c <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o 1 <br /> New BuildingT No. Bedrooms ' <br /> ,,,.�, ype of Construction: ••••••• • R <br /> AdditionGA KA54 Septic Tank Size Gals. .......... <br /> ... . . . ........................... .. <br /> ^ .......... <br /> Sanitary .......... Size ...�...... ft. x .....�7... ft. ; <br /> Filling/Grading .......... Height....K....... Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... i r i <br /> ........................................... O <br /> Mobile Home .......... Slope .......................................... ^ <br /> Perc. Rate ................................... m <br /> Privy .......... 3. Use (describeexactly, 1 -family o <br /> Well home,garage,motel, etc.) Dry Well .......... m <br /> Subdivision .......... uf4<4aa — P C < Seepage Trench Z ' <br /> o <br /> Camping Unit .......... ..='....ti).Jpaw S... .I�OC•t2.` ..... Privy .......... .1h1 <br /> `/ "�' Seepage Bed t <br /> --------------------------------------------------------------------- O En E� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at Ur <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. :�1 `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. --- <br /> ------------------------------------------------'----------------- :/JI :V1 <br /> } <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x ft. - ......... / T/ iEri� p-.�`... ..a"............... pCCQQ11' <br /> .............. ........... .... sq. ~t7 4 J .. <br /> ..... .. s ft. ................. ....� ... .... ... <br /> Gcr tt ' I, h�q O -1;1 <br /> j /\.. <br /> � r <br /> o <br /> ' <br /> Sirx F.✓'t�erne C6 � / / � i t �. <br /> cQ11` 0 <br /> Oe'., <br /> l <br /> ,Dh - '' 1 Z <br /> T �s a z7�' <br /> -tzi;140 <br /> Sq, h C� <br /> D mm W r D 1 W m <br /> 8 P : `G N 0 <br /> ZO `G y <br /> 1 cn� c a ; m <br /> f o m <br /> Si nature of Owner dor A J `! l.7 <br /> . . ................................. ............................... ...... •r .. <br /> g g nt Date <br /> o : <br /> Remarks m <br /> N . <br /> ......................................................................................................................................................................... <br /> u <br /> ................................................................................................... <br /> � ....... <br /> Inspection Date • N m N N <br /> Zoning ministrator � o <br /> NOTE: A preliminary site inspection must be made and site approval granted 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 application 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 been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or 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 APPROVED. <br />