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.irnett County Office of Zoning Administrator i o <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 located as s' <br /> o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m z <br /> Ord <br /> inance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a i� <br /> �1.4.fi�i✓....�iU ��l./Jr*?(...-�a<4n ..... ot /...�olrx ................/ Pallf7(t..C.. f...................................... 3 o <br /> a <br /> OWNER (please print) _ CONTRACTOR or SURVEYOR or AGENT Cx7 I- <br /> (� ri <br /> ...._.A.a..X.......3.3.0.................................... ...... . .... .......IV./............................... <br /> ADDRESS ADDRESS <br /> - � w . ........w..i.............s-Y y�........ <br /> ADDRESS ADDRESS <br /> L�L ..................................................... . ........... ............. <br /> PHONE PHONE <br /> ........................................................................................... .WE.. LL DR............I.. ...LLE.. R...................................................................... <br /> PLUMBER <br /> ........................................................................................... <br /> ADDRESS ADDRESS <br /> n o <br /> < it <br /> PHONE .............. ..•...•.• PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° �q <br /> 1. Work: ( 2. New Building Details No. Bathrooms .......... o ` <br /> New Building •...V. Type of Construction: No. Bedrooms .......... V\ <br /> Addition COMMEJ?�/FL &�{L,...�UILO/�`�' Septic Tank Size Gals. .......... `� <br /> .......... " pr' <br /> Sanitaryfr y Z .......... <br /> .......... Size ...Z......... ft. x ...... .... ft. <br /> Filling/Grading .......... Height...5...... J&�ttDries ...../....... 4a. Absorption Field Site: <br /> Moving .......... Area /D 9 Soil Type .................................... r <br /> ................................. ....... <br /> Mobile Home Slope .......................................... 0 <br /> .......... <br /> Privy .....•.... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> r <br /> Well .......... home,garage, mote eta) Dry Well .......... — E <br /> Subdivision Seepage a e Trench .......... <br /> ......•... .S RZ} ; C <br /> ...... .... . ..... ............ <br /> Camping Unit .......... Privy .......... <br /> .................................................... Seepage Bed .... yJ <br /> ...... I i i <br /> ----------------------------- ------------------------ (� N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road I <br /> Ci- <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Inter- iy d <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> i <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> ---------------------------------------------------------------------- J <br /> 5. Lot Size: s Fig. A. 6. Location: fr�j i <br /> ................ ft. x .............. ft. — ...... ..A" <br /> ............... sq. ft. .................... . ..........................................., , <br /> P <br /> N <br /> m <br /> n <br /> N O <br /> O J <br /> J n, <br /> J w <br /> V <br /> ti I <br /> w <br /> d <br /> L <br /> mZ <br /> l Ce 2 <br /> oo d a m <br /> 9 O1 ;. . : : ,� ro c <br /> 4 z .0 n <br /> l Q <br /> . ....... ....�j.... , .... ...1�. . . . ...........�5 r �= p <br /> o c <br /> Sign re of Owner or Agent p� X � <br /> Remarks ......................................................................................................................................................................... r m <br /> ;Q) n <br /> ........................................................................................................ .... <br /> . . .............. .. . ........... vl <br /> Inspection Date ....................................... ��CF'�P ..... <br /> ..7v 9 v m <br /> .............. ...�.....�..'..'.�..�. : I O N O U m <br /> Zoning Admin strator ,XJ 8 0 0 0 0 o ti <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 he 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 />