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Burnett County Office of Zoning Administrator o/J o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. � <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a :\ r\ <br /> . .Ty..,....:rS4' [/t.-l.......W...:..................... .....................................................................I...................... <br /> OWNER Iplease pnntl CONTRACTOR or SURVEYOR or AGENT as <br /> / . .. .d... ./ N....O.K.........��1� .. . ............................................................................. a <br /> ADDRES /j� ADDRESS <br /> / tv.. .7 n <br /> .f......... ?...........�./�I/ ......................................... ............................................................................................ 9a <br /> ADDRESS ADDRESS ' <br /> �..q.b .-.6..5.. ... ... . ... . k �i... . i ........................ . ................................. ............................. <br /> PHONE <br /> ........................................................................................... . . . ..................................................................................... .� <br /> °LUMBER WELL DRILLER <br /> O 1 <br /> ........................................................................................... .AD.....D.. E <br /> R....SS................................................................................ u, <br /> ADDRESS [ O............ p O' <br /> ........................................................................................... ................................................... ........................... <br /> PHONE PHONE Z <br /> DESCRIPTION 4. SanitaryFacilities: P o <br /> 1. Work: No. Bathrooms ' <br /> 2. New Building Details <br /> No. Bedrooms .......... a <br /> New Building ...V„. TypGG of CoPpstructton. m <br /> Addition ,.((fJ,7„a„cJ... ..,/1�, ,.„,,.„.. Septic Tank Size Gals. .......... <br /> .......... E�: < <br /> Sanitary .......... Size .....46?'_ ft. x .....1.00.... ft. .......... <br /> iPilling/Grading Height2 ... Stones ............... 4a. Absorption Field Site: <br /> .......... <br /> Moving .......... Area ......................................... Soil Type ................... <br /> ................. <br /> r i <br /> o <br /> Mobile Home . . Slope .......................................... <br /> Privy Y, Y Pere. Rate ................................... <br /> .......... 3. Use (describe exact) 1 -famil ; <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision S"'y0 r� �.� sl�„� Seepage Trench .,......., <br /> Camping Unit ,,,,,,,,,, Privy .......... 1 <br /> .................................................... Seepage Bed <br /> .......... <br /> ------ ----------- --- --------- <br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc., should be sketched in Fig. A. Include road W <br /> setback, side and back property g y <br /> yard dimension and location and setback from all bodies of water. If ropert Is located at a hi hwa inter-section, show the intersecting highways and the setbacks required 'along them and at the Intersection. CLEARLY LABEL EXISTING <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. � p <br /> ------------------------------------------------------- <br /> 5. Lot Size: I� Fig. A. 6. Location: <br /> .... .... ft. x ...�..ol. . ................. ............ sq. ft. ............................................................................... <br /> IJ-IT D j <br /> lai <br /> n <br /> N o' <br /> p <br /> � � a <br /> � � <br /> a <br /> T 0 <br /> z <br /> //-- O <br /> to <br /> 7 <br /> N � <br /> Nr M m WZ <br /> n Cr G <br /> Ce Ce C d d m <br /> Z O <br /> o am 3 <br /> Ch — <br /> 0 <br /> ��. p <br /> Sign re of Owner or Agent Date X <br /> -n m <br /> Re arks ......................................................................................................................................................................... In <br /> �; M <br /> ... ................................................................................................................................................................................... :NII <br /> ........................................................................................................ <br /> Inspection Date ....................................... Wlf:FGfI /-- .... \� N o o P m <br /> ..... ...... . . . ... ........... o o m <br /> Zoning Administrator �'J 8 8 8 8 8 8 w <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 /> 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 />