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'r9-^IL4:79 <br /> Burnett County Office of Zoning Administrator --i 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 n <br /> d G '\ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a ; <br /> �/�.� /.` N N m <br /> OWNER (please printf CONTRACTOR or SURVEYOR or AGENT c, m <br /> a <br /> ................................. - <br /> . 4 <br /> ADDRESS ADDRESS <br /> ............................................................................ . ......R.ES.................................................................................. �q <br /> ADDRESS AD.. DS <br /> ............. <br /> .............................................................................. .PHONE................................................................................ '� 1 <br /> PHONE _l <br /> ............................ ....fx-1 1' <br /> .. .. <br /> ....................... ............................................................................. o <br /> PLUMBER WELL DRILLER <br /> .....Y..l.. ...c'..�1. 1....�7.........'..."..... N p <br /> ADDRESS ADDRESS NA <br /> o <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> ; <br /> 1. Work: 2. New Building Details No. Bathrooms ...�...... s O <br /> New Building ,,,,,,,,.. Type of Construction: No. Bedrooms ...: ... ;\ <br /> Addition Septic Tank Size Gals. -..... a� i <br /> �.� P <br /> :1 �..................#. ......... .......... i <br /> Sanitary .......... Size .......:...... ft. x ft. <br /> / 4a. Absorption Field Site: <br /> Filling/Grading .......... Height............. Stories ............... <br /> Soil Type .................................... .. i .0 i <br /> Moving .......... Area ........................................... o <br /> Mobile Home Slope .ate ................................... C <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ....................../.'.....3.... VJ <br /> Well ...�. .... home,garage, motel, etc.) Dry Well .......... "19 <br /> Subdivision .......... .................................................... <br /> Camping Unit Privy .......... � <br /> Seepage Bed <br /> ___ <br /> _— _—__________ O ;� <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road �:' � <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway Internk <br /> - <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING vl o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. W 0 <br /> ------------------------- --—— <br /> 5. Lot Size: Fig. <br /> A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... .� <br /> N <br /> N <br /> O O. <br /> J <br /> O QV <br /> O <br /> 0 <br /> H <br /> _S <br /> 1 � <br /> A\ T <br /> L [� <br /> Z <br /> 0 <br /> M <br /> a <br /> m <br /> C <br /> on c n <br /> Z O o n 77 <br /> o J n 3 <br /> 510 <br /> dna <br /> '"" m...�... ./.. .... ........ Cof,Owner or Agent / D to p <br /> Remarks .../.........�,)CLSL'... .../.!.ULbe.....�!`v.... ??�......... ...12.1 (.....!.. .!�!...... ..... M " o <br /> ...................... ................................................................ ......................................... ' <br /> vet< .. � <br /> n . �t <br /> In <br /> Inspection Date .., ....vZ.6...-`F•s..... ... ... .......�...... . ... ................................... 1E o u o 'oo rn <br /> Zoning Administrator 1 g 8 g g o $ y <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 /> _ith 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 />