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Burnett County Office of Zoning Administrator -- 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ;wW 3 0 F: <br /> 0 <br /> TO THE ZONING ADMINISTRATOR- The undersigned hereby makes application for a Permit for the work described and located as < 7 <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 a <br /> r-c0,��Nc S«x( v,Cky v o <br /> ....................................................... . . . .. N-T.I . . . ................................................................ ....... N <br /> OWNER (please print) ��L�cS CONTRACTOR or SU RVEVOR or AGENT n <br /> li......./ v.�.R.i.Cc ..........+r,[,S: .... ............................................................................................ <br /> ADDRESS ADDRESS <br /> ............................................................ .............................. . .......................................................................................... <br /> ADDRESS ADDRESS <br /> y.7".- 3 3. ....................................................... <br /> PHONE PHONE <br /> PLUMBER............................................................................ WELL DRILLER.................................................................... � i <br /> .................. .................. <br /> ADDRESS ADDRESS m L) <br /> n o <br /> o........................................................................................... ............................................................................................ <br /> PHONE PHONE Zr <br /> DESCRIPTION 4. Sanitary Facilities: 0 0 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details """"" o <br /> New BuildingTYpe of Construction: No. Bedrooms .......... ss o^ <br /> ^\1 <br /> Addition .................................................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................... ............... Soil Type .................................... <br /> Mobile Home .......... Slope .ate ................................... '+ � <br /> Pere. Rate ................................... :�> i <br /> Privy ....... 3. Use (describe exactly, 1 -family .-,. � <br /> Well home, garage, motel, etc.) Dry Well .......... 'i <br /> Subdivision ..... .... Seepage Trench ...._.._ r <br /> . .................................................... . <br /> Camping Unit .......... Privy .......... III <br /> .................................................... Seepage Bed <br /> ....... i <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should he sketched in Fig. A. Inc'ude road Q <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING vj <br /> a <br /> STRUCTURES AND PNOPOSED STRUCTURES AND ADDITIONS- o� <br /> - ------------------------- <br /> 5. Lot SizeCrn�J -(. Fig. A. 6. Loca ton: <br /> ....y.(..... ft. x �..3,.?- i . - ....!?..L.V.T.p........ <br /> sq. ft. ..�......................... 7 <br /> 3 dui . N <br /> N <br /> / N O' <br /> o r <br /> o <br /> ski <br /> J <br /> I <br /> X W r na :E d m Z <br /> N sod 4 < F <br /> N <br /> do C: : _ m <br /> Z C) n M <br /> o r m <br /> va - <br /> P, o <br /> O . <br /> O <br /> cmc ............... p <br /> Signature of Owner or Agent ate - <br /> X 7J <br /> T <br /> Remarks ......................................................................................................................................................................... m m 0 <br /> m <br /> <n ' <br /> ........................................................................................................................................................................................ - <br /> ................................................................................................................ .. ...... ....-.................................... !� <br /> j N <br /> ... ..... . ........ \ <br /> Inspection Date ....................................... ...... . ....... .... ...oning m� I m <br /> C io Noma o <br /> .. ... ... ........................ N N <br /> Zonin ministrator '0 0 0 0 o of <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 he Issued. Do not purchase or Install a septic tank, do any plumbing or stalt any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the Information conveyed hele- <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 />