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e5t-/7 6-6-z,..E,p• <br /> Burnett County Office of Zoning Administrator 00 <br /> --1 <br /> o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 = <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a ;, <br /> VJO AI .r'. KSP..^�.......... Cu .�....T .d ?. s....................... <br /> OWNER/(}��Jlea};.print I �Q� / D CON RACTOR or SURVEYOR or AGENT <br /> ..... . ....It` 1 �a4................................1/1.� . . .......................................................................................... <br /> . . <br /> ADDRESS S / � ADDRESS <br /> (,eke .....�..�...�................... . ........... . .......................................................................................... <br /> ADDRESS ADDRESS <br /> PHONE PHONE <br /> ........................................................................................... . ...................................................................... ................... <br /> PLUMBER WELLDR ILLER <br /> .......... <br /> ........................................................................................... <br /> . ....D.RES.......................................................................... � 0 <br /> J <br /> ADDRESS AD.. S 0 <br /> ..................................................................................4........ . .......................................................................................... o <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> v .r <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> No. Bedrooms a <br /> New Buildingr� m ' <br /> .,,^...,, Type o gqnstruFtioJ{'. <br /> Addition �/F Septic Tank Size Gals. .......... <br /> X..... .................................... <br /> Sanitary .......... Size ..a�.�y..... ft4 x ft. ..... <br /> FillinglGrading .....4.... Height..... .. . .. Stories .. ......... 4a. Absorption Field Site: `. <br /> Area ).1`tl ....... Soil Type .................................... r <br /> Moving .......... ....�.......... .. .. ..... .. O <br /> Mobile Home �y X�B A11G176 f/oin e- Slope .......................................... r. <br /> Perc. Rate ................................... <br /> Privy 3. Use (describe exactly, 1 �family � <br /> Well home,garage, motel, e]�}���j,``) ,,// Dry Well <br /> Subdivision ,,......,, .3 C<tS�"' RODwI /xrarfr0'� T 9'-x Seepage Trench .......... <br /> .�.�. .. .......... ..... Privy .......... <br /> P e S/I¢G <br /> CampingUnit .......... — ... ..... ............... ....................... Vti <br /> __ Seepage Bed .......... <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road Q i� <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property rs located at a highway inter < <br /> section, show the intersecting highways and the setbacks required along them and at the intersection-CLEARLY LABEL EXISTING ( I „7—, p <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. C o <br /> 5. Lot $�ze. y -� Fig. A. Lo�ation ,�� S� I/ `.� //--. 4jpN_ :th <br /> . ft. x y ft. ....... ... ........ s9.ft. ....... .....1... ........l. F 1 ... .. <br /> J ff <br /> 1777 ,��+r7TON o 0 <br /> CLU 35PuSonl h7aon-. '— y,� <br /> e/Uy `n <br /> ® - Sewer <br /> To Loi' <br /> 0 <br /> 64 <br /> Utie <br /> i r o <br /> ( o <br /> s <br /> 3 � <br /> xt 01 1 lei U <br /> SIoeP to � _9 � d�_ <br /> 3 < , F <br /> C, m <br /> m � o _. m <br /> v <br /> Z a � <br /> 0 <br /> a . U _ $ <br /> Ou� o �o <br /> -- o <br /> c�=T85X................ ... ... .... ........ <br /> Signature of Owner or Agent Date X <br /> � : m <br /> Remarks ......................................................................................................................................................................... <br /> n <br /> da <br /> ........................................................................................................................................................................................ it <br /> .... ..........r..... ... <br /> :C: o8 N8n o8 lrn8P Dn.................................................................................................... . . ..m ............rIns <br /> Inspection Date ....................................... . f...... . .............. <br /> .. ZoninAd <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 revoker) 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 INSPECTED BY THIS OFFICE AND APPROVED. <br />