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Burnett County Office of Zoning Administrator a o �o` <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> 3 . <br /> TO THE ZONING ADMINISTRATOR The undersigned hereby makes application for a Permit for the work described and located as 'G — <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use rs C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> sN.l�y...................... <br /> � o <br /> .................. <br /> OWNER z}— <br /> (please print) CONTRACTOR or SURVEYOR or AGENT <br /> .`1......U.p.Pe....73a�....S7, E 1. G,Bis. K.E.................................................. a , <br /> ADDRESS ADDRESS <br /> -......D75 <br /> AD RESS ADDRESS <br /> :i <br /> « - . 5.1. -.agcy .. . ... .... .... ..... .... ... ag- 3 -5...... .... ... . ..... . . <br /> ... ..... ..... <br /> PHONE PHONE <br /> ........................................................................................... ............................................................................................ <br /> PLUMBER WELL DRILLER 101, <br /> O <br /> ........................................................................................... ............................................................................................ —. <br /> ADUR ESS ADDRESS m L1 <br /> n o T <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building .,,,,..,,. Typ of Construction: No. Bedrooms .......... All <br /> Addition „n„.. /�( 50N R'I Septic Tank Size Gals. .......... . : '• <br /> . .......... . - <br /> Sanitary .......... Size ..A.9..... ft. x ..J.a"... ft. .......... 4. XJ <br /> Pilling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: i <br /> .................................... r <br /> Moving .......... Area ........................................... Soil Type � o <br /> Mobile Home Slope .......................................... P •+ i <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well ...I...... ho e,garage, motel, etc.) Dry Well .......... <br /> Subdivision ,.,,,,,,,, .IJNjj�27C4571 <br /> .......... Seepage Trench .......... <br /> .T... ........ . Lei <br /> Camping Unit „� � Privy .......... <br /> --}r <br /> ............................... . Seepage Bed <br /> ------------------------------------------------------------ <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched In Fig. A. Include road <br /> C7 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <br /> _. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING y <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. pUp )� 5' <br /> __---------------------------------------------------------------------- `F' <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. <br /> a <br /> � n <br /> No <br /> C v <br /> SEC <br /> � 0 <br /> ) <br /> f a <br /> TI �` <br /> �� z =.Z <br /> 0 <br /> u, <br /> m <br /> E <br /> 7 <br /> on - M :E m Z <br /> n c < P m <br /> so <br /> a ¢ F <br /> - n <br /> VI G y : b M <br /> m m <br /> 0 O o a 37 <br /> 0 j <br /> k7n /i J 3 � m <br /> ... .'..... `......... ...................... lig. . 7 O <br /> Signature of Owner or Agent V Date x <br /> m m <br /> Remarks ..` .......................................::. .......................................................................................................................... <br /> ..................................l ..�...... �L—::- '/)itf $� �� / <br /> .................. ........................................... ...................................................................................... II <br /> ............................................................................................................ <br /> ..............................1. ..../.J....................... ............... d <br /> Inspection Date ....................................... ..... ..IZhJ... .......A..Yf.V .. ..... ��o)N m <br /> Zoning Adminis a ir E 8 $ $ $ 8 8 rn <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 INSPECTED BY THIS OFFICE AND APPROVED. <br />