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.v"7" <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY— LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wiscpnsin. 3 gi <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> .. +.....1......................... . ............................................ . ...... . . ....................... ...............................................ISL....... a °� <br /> ADDRES ADDRESS 01 <br /> U1.: ..........�-.. .....its..........V.8 <br /> `13............ <br /> ADDRESS ADDRESS <br /> ..... ................................................................................................1I <br /> ............... <br /> PHONE PHONE <br /> ..................................................................... ....... ............................................................ <br /> .......... ......................................... ...... ........ . <br /> N <br /> PLUMBER WELL DRILLER v <br /> ..........W...............................................-e .......................... . . . . . . . . ' <br /> ADDRE - ADDRESS O M <br /> hodn o i <br /> ......... ................ ......... n <br /> ................................................... ...................................................Y..............................�L....... <br /> PHONE PHONE o <br /> .. <br /> Z <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 0 ' <br /> 1. Work: No. Bathrooms �J J <br /> 2. New Building Details . •..•.... E� o <br /> New BuildingT No. Bedrooms a :O <br /> ... Type of Construction: .� —� „ '� <br /> Addition .. ....... Abs Type <br /> ...Fi ............. ........ J < <br /> Septic Tank Size Gals. <br /> Sanitary Size .............. ft. x .............. ft. <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: +� , <br /> At <br /> Moving .......... Area ........................... ........... �`y { / :F o '•� <br /> Mobile Home .......... .... Slope ........... '..1.�.'...)..... :�. <br /> Privy .......... 3. Use (describe exactly .}� Perc. Rate ........T.......:'C...-.L(.... ? '• <br /> Well ,......... home,garage, motel,etc.) Dry Well . ........ <br /> Subdivision Seepage Trench <br /> . ........ <br /> .................................................... <br /> Camping Unit .......... Privy :Q.. <br /> .................................................... Seepage Bed . . .. i.(• <br /> -------------------------------------------- 7 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig. A. Includ 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 I 0- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXIS ING N <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> ---------------------------------------------------- -------------- - (��'), � . <br /> 5. L tSize: Fig. A. 6. Location: W <br /> .. .. ft. ft. — ............................... sq.ft. <br /> ..................................................................... <br /> ........ <br /> O <br /> N o <br /> X14 <br /> 1t <br /> J� z <br /> o <br /> a <br /> I <br /> W Z <br /> q <br /> N N d C' m <br /> iD < X c M <br /> Z C) n m <br /> .0 <br /> o <br /> Signature of Ow er or_ gent Date ! x C <br /> Remarks `'.....!..�..,.,�f:.......:�...:,............................................................................................................................l..... m <br /> ........................................................................................................................................................................................ <br /> 6 <br /> .............................. .............................................................................. .... ................... ./ . IL.... <br /> 1 m <br /> / :J1: H <br /> Inspection Date .2`..... .�:...... .4.:........ ...... .. 9. L� ....�-................�.... a m <br /> m <br /> Zonin Ad istrator :�: 8 $ $ $ $ $ y <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 lie 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 thle Zoning Adm inlstrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />