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Burnett County Office of Zoning Administrator P o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and locat d 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, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0 i\ <br /> s <br /> XON ffp.(!f�fi _ o <br /> OWNER (please print) CONTRACTOR or SU RVEV OR or, AGENT CL <br /> .............................. .................................................................................... ....... o <br /> ADDRESS ADDRESS n <br /> ...... .................................................................................... ....... <br /> ADDRESS ADDRESS <br /> b...� .-...7..77.-. . .Y. ................................. .................................................................................... ....... <br /> _ <br /> PHO�NjE PHONE <br /> {. !J(. .... .f5. A............................... I V <br /> PLUMBER WELL DRILLER <br /> . .................................................................................... ....... <br /> ADDRESS ADDRESS o <br /> 7<. .-.. 6.. -...Y.1..................................... g <br /> PHONE PHONE Z y 17 <br /> DESCRIPTION 4. Sanitary Facilities: ° t o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Buildin Details <br /> New Building .......... Type of Con9structioA: No. Bedrooms ...r.�..'... O <br /> Addition „ ,,, , ,WC7t'Sj2.... /�HME Septic Tank Size Gals. <br /> 0 <br /> Sanitary ,.r .,,, ii -rak'w <br /> Size ....�..Q.... ft. x .... .0.... ft. <br /> Filling .......... Height........... Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................... ............... Soil Type ..... 5;................ <br /> Grading Slope .......jr,b.................... 3O <br /> r <br /> o <br /> ........... <br /> L... .. ..... <br /> Mobile Home .......... 3. Use (describe exactly, i -family Perc. Rate .... ... C <br /> Privy .......... home,garage, motel, etc.) Dry Well . ........ T. <br /> Well Seepage Trench ; <br /> .......... .......�..-. �+ r.�.� .... M <br /> Subdivision Priv . ...... . � � E <br /> .......... .................................................... Seepage Bed /a)C3.Sy 41 <br /> � <br /> ---------- — — — -- --- — — — <br /> ----- ----- ---- --- ----- -- — ----- `{- <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 inter _a v <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING L <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. � <br /> ------------------------------------------------------------------- -- \VI� <br /> 5. Lot Size: Fig. A. 6. Location: i K- <br /> ti Z <br /> ................ ft. x .............. ft. — ............................... sq.ft. ...................................................................... ........ <br /> gEE>'A6E a <br /> gap <br /> 27,Sr � p <br /> t T <br /> �T Z <br /> pliuE '� DoT <br /> Exls�INC <br /> > <br /> I JljlllLQlN(e � <br /> AoofTlD� I �4 <br /> 10 x;vz �z 701 cn r v w <br /> oH, H : m <br /> Z oo fD i i m 77 <br /> el-AM MSG o <br /> �o <br /> 'L m <br /> '� ` .................. ......... .ra. .... ......... o <br /> Signature of Owner or Agent ,Date X <br /> Remarks .. .,a... �.: ...Y.:L.Q.Y..Ci-. .:'................................................................................................................... .:... -1 i E ? i i� � � <br /> M <br /> // _�r <br /> ........................................................................................................ ................... ....................................... <br /> . . .......... ......... .. to <br /> Inspection Date .1/...C�'.. :....�z. ...... / '..... .... . ::9 o o'o0 0 o m <br /> .. ... .... .... g .... . .... .... ........... ..... <br /> Zoning Admini rater o 0 0 0 o to <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 plu hing or start any build <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the inf rotation conveyed here <br /> with is found to exist. Changes in plans or specifications shall not he made without approval oft e Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />