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Burnett County Office of Zoning Administ ator 0 0 <br /> _ <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and loomed as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use <br /> Ordinance, Sanitation Code, and with all <br /> oother applicable County Ordinances and the laws and regulations of the State of Wisconsin <br /> CL 0 <br /> CT�h..hi. .r 1 CZ. !( ......5.!/.�1... .. . / C/ ....... ............... .. ........... ...... 3 <br /> OWNER (pleas CONTRACTO S RVEYOR or AQtNT a J <br /> s1 ........ ..7` ... 4 ..I`-..���.. ...... ..., ././... ° �� .? Q'U.e....... .. ...... <br /> A R SS AD ESS <br /> ADDR5SS / ADDRE S <br /> .. ........... .../ . . . .. . . ..... ...... . ..... �.... .... / . ...... ........ <br /> PHNE................................................................................ PHONE <br /> PLUMBER WELL DRILLER <br /> O <br /> ADDRESS ADDRESS � o <br /> _� c\ <br /> .................................................................................. .PHO"H'0-........................................................................... ......... p N <br /> PHONE NE Z <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms9 <br /> 2. New Building Details ........• � o <br /> New Building ...,,,.., Type of Construction: No. Bedrooms ......... <br /> Addition ........., ........................................ ... „ Septic Tank Size Gals. ......... <br /> Sanitary .......... Size ft. x .3 ... ft. <br /> Filling/Grading ,......... Height....�/....... Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ..G7?�1.AIA..1/AZ. Soil Type .................................... � \ o <br /> Mobile Home Slope .......................................... C7 ^ <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... o� <br /> Well .......... home, ac,ara_ge, motel tc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... ;\ <br /> Camping Unit .......... Privy .......... a <br /> .................................................... <br /> Seepage Bed .......... <br /> -------------- — <br /> -- be <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched in Fig_ A_ Incluc e road <br /> setback, side and back yard dimension and location and setback from all bodies of water. I1 property Is located at a highwa inter- a <br /> section, show the Intersecting highways and the setbacks required elms them and at the Intersection. CLEARLY LABEL EXISTING I�� a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i` i — <br /> ------------------------------ <br /> — ------ ------------------ ---- <br /> 1. <br /> -------------------------------- — -- ---- — _ _ _— V� <br /> 5. L �e: Fig. A. 6. L a on: t <br /> h SSw777: y s� --------/--1----�-- ---- <br /> �ll...`........ ft. x(il...fl.�.� ft. — od......... sq. ft. ' ... .�..�'7.....F.--:Z..C,�... .... ..... ... � <br /> .. 7•. ? ? i <br /> �y 1� <br /> be <br /> N V o. <br /> o ( � <br /> r w ro <br /> w z <br /> v <br /> cr _. d - m <br /> � U1 < C . ,� ro . <br /> EA <br /> �o <br /> g G�j o C <br /> ria re tuof Or or wneA ent Date <br /> X � <br /> T <br /> Remarks ......................................................................................................................................................................... � mp <br /> m : <br /> u <br /> ............................................................................................................... ..... ....... ......... .................... ..... .... . . . <br /> Inspection Date N N . m ' N T <br /> ....................................... ...�... .... .... .... ..................... ....... s umom m <br /> Zoning Ad trator o 0 0 0 8 <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 percoldtioi test most be attached to <br /> this application before a permit will be issued. Do not purchase or Install a septic tank, do any pl tmbing 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 he Zoning Adm inistiatot . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />