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Burnett County Office of Zoning Administrator dz <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT '- 3 0 \0�\ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett Cou <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < {� <br /> 0 <br /> cry Land Use c •V\ <br /> Ordinance Sanitation Code, and with all other applicable County Ordinances and the laws and re ulatio sof the State of Wisconsin. <br /> g 3 0 <br /> a <br /> OWNER (please pri t TO��VEYOR or AGENT <br /> m <br /> v, � <br /> a \ ' <br /> ........................................................................................... - <br /> ADDRESS ..... ... ................................................................ <br /> ADD E S o <br /> m <br /> ........................................................................................... .. .y1/� //��(� _ <br /> ADDRESS ... % Cr'.ZC/ ...!tM1�V,!........................................ <br /> ADDRESS <br /> ............................... . <br /> ............. .............................................. <br /> PHONE ............................................................................................ <br /> � <br /> PHONE <br /> ........................................................................................... <br /> PLUMBER . .......................................................................................... <br /> WELL DRILLER <br /> .............................................................. ..... .... ..I..... <br /> . . . <br /> .... <br /> .. . ....................... <br /> . .. ...... . . ........................................................ O <br /> A <br /> ADDRESS ADDRESS - <br /> n <br /> 7 o <br /> PHONE ............................................................................................� <br /> PHONE o M <br /> DESCRIPTION Z <br /> r <br /> 4. Sanitary Facilities: 0 <br /> o <br /> 1. Work: 2. New Building Details No. Bathrooms + 0 i <br /> New Building No. Bedrooms F O <br /> Type of Construction: ... y -� <br /> Addition Septic Tank Size Gals. ..... ....^ <br /> Sanitary .......... .................................................... A <br /> y .......... Size .............. ft. x .............. ft. ....... . 7 <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type ..................... sJ <br /> ............... r <br /> r <br /> Mobile Home Slope � o <br /> .......... ..........................................4 <br /> Privy <br /> ......... 3, Use (describe exactly, 1 -family Perc. Rate ...................................G <br /> Well / home,garage, motel, etc.) Dry Well <br /> Subdivision Seepage Trench <br /> Camping UnitPrivy <br /> .......... ......................4.........................I... .......... <br /> ________________ Seepage Bed <br /> ________ .......... f <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., shoultl be sketched in Fig A. Include road N <br /> setback, side and back <br /> yard dimension and location and setback from all bodies of water. If property Is located at a highway Inter- a <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. <br /> ------------------------------------ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x .............. ft. . ............................... sq. ft. i <br /> ............................................................................... <br /> N <br /> IN <br /> 00 <br /> 3 � <br /> M <br /> z <br /> 0 <br /> d <br /> m <br /> I — <br /> 3 N 9 N <br /> jW 2 <br /> c ry <br /> o v o am 3 <br /> 01 <br /> 0 nin <br /> p <br /> Signature of Owner or Agent .....................""".""""" <br /> Date o <br /> Remarks ................................................... <br /> .. ...... ......... r m <br /> ................................................................................................. ... . ro O <br />........................................................................................................................................................................................ isn, <br />......................4......... <br /> ........................................................................ <br /> Q (� <br /> Inspection Date ....................................... . . / ! .. �" <br /> ...... ........ ... V m <br /> ... uor�n oa m <br /> �.. ....Zonin A nlstrato 8 8 8 8 8 8 ti <br /> IOTE: A Preliminary site inspection must be made and site approval granted on all structures involving salary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> Ig until a permit has been issued. A permit may be revoked If misrepresentation of any of the information conveyed here <br /> - <br /> rith 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 />