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Il CNP <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 t1\ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < _ <br /> xv <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, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> H <br /> rac'�n .................................................. ..... era.l.d....E:....... ....... .rVj .....,........................ <br /> OWNE (please rind CONT ACTOR or SURVEYOR o' AGENT a <br /> O <br /> ago /�o.. ...�r.�`. q ...... ( l�ebst�r.,... a <br /> ............................ x/ 9.3........... <br /> A........ ... ADDRESS__PESS Poo-it <br /> l...� ...5✓71 .......................... ............ . .. ... . .. .. ..... .... . ...... <br /> ................. . ........... ..... <br /> 1.......... <br /> ADDRESS ADDRESS <br /> aC.u. ........ <br /> ........................................... .................................... <br /> PHONE PHONE <br /> ........................................................................................... ............................................................................................ <br /> PLUMBER WELL DRILLER P <br /> O <br /> ADDRESS ADDRESS ' m L1 <br /> n o <br /> ........................................................................................... ........... ........... o <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms ° <br /> 2. New Building Details •"•""" o <br /> New Building No. Bedrooms ! r. <br /> .......... Type of Construction: m <br /> Addition .................................................... Septic Tank Size Gals. <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filiingl Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area . . . ....................... . ... <br /> Soil Type ..........................+........... <br /> Mobile Home Slope ....................... . . <br /> O o <br /> . .Privv .......... 3. Use (describe exactly, 1 -family Perc. Rate ..................... . ... ....... r <br /> Well Dry Well <br /> ,,,,,, .. home,garage, motel, etc.) """"" <br /> Subdivision �� Seepage Trench .......... <br /> 70 <br /> Privy <br /> CampingUnit .......... .................................................... ......... Va <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures, wall, sewage systems, roads,etc., should he sketched In Fig_ A. Include roadC <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter Ia <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. i o � <br /> ------------------ <br /> - _.__ <br /> 5. Lot Size: Fig. A. 6. Location: `m <br /> ................ ft. x .............. ft. — ............................... sq.ft. t <br /> N O <br /> 0Pap- <br /> 7 <br /> I ®l • 11 <br /> I <br /> See Cow�•t f�v��.-( P <br /> 'a G✓t-� z <br /> � <br /> A/) m?GiC'6v d <br /> - w w Z <br /> a C - m n m <br /> N. M n <br /> Zn <br /> 1 O o na :3 <br /> ro 'e <br /> an o <br /> .. .........Q-�� - <br /> o <br /> .............. ] <br /> 0 <br /> Signature of Owner or Agent Date <br /> X ] <br /> T <br /> Remarks ................................................................................................................................................................�......... n� � E <br /> en <br /> ......................................................................................................................................................................................... <br /> .............................................................................................................. v� $msoInspection Date ....................................... .... ......... ......... U H <br /> n:.. .. ... <br /> Zn dmran <br /> 6 <br /> NOTE: A preliminary site Inspection must be made and site approval granted on all structures involving sanitary facilitios <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 Adm inistiato+ . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />