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Burnett County Office of Zoning Administrator u 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o 9J <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as ?W <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 /> Gt''0.2 c <br /> 1..................... °' <br /> ...C.:....Cv�.'. ............. <br /> OWNER (Pleas print) CDNTR ACTOR or SURVEYOR or, AGENT � <br /> // +tet xiz a ' <br /> ...........f. ...../....... .�. ........A .............. •........................................................................................... a :G <br /> ADDER SS ADDRESS <br /> �e6e,..7�«.....,..../V/..........:5�f�3 <br /> ......................... <br /> ADDRESS ADDRESS <br /> ........................................................................................... .................................................................................I.......... <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... ..A.......... ................................................................... <br /> ........... O <br /> .Z <br /> ADDRESS DDRES..S <br /> i O V' <br /> _. c <br /> . . ................................................................................... ..PHONE.......................................................................................... •Z ? 1-7PHONE � <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No.2. New Building Details •••••••••• o <br /> New Building <br /> .......... Type Construction: No. Bedrooms .......... <br /> Addition ...... <br /> YY /�6hF Septic Tank Size Gals. .......... <br /> ....�.... . ........ . ................... .. <br /> yy .......... < <br /> Sanitary .......... Size ...A......... ft. x .. ..y... ft. <br /> Filling/Grading „ ,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r i <br /> Mobile Home Slope .......................................... 3' <br /> Privy ........., 3. Use (describe exactly, 1 -family Perc. Rate ................................... f <br /> Well home,ga age, motel, etc.) Dry Well .......... S <br /> Subdivision •.•••••.•. �!t• hh,...... Seepage Trench .......... <br /> Camping Unit .......... ........................ Privy <br /> .................................................... <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc.,should be sketched in Fig A. Include road CN e <br /> setback, side and back property highway yard dimension and location and setback from all bodies of water. If ro erty is located at a hi hwa inter- a ' <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING UI <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I H <br /> ---------------------------------------------------------------------- G <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ...r"T..'>✓�.�.�:5........ sq.ft. ............................................................................... oo <br /> O <br /> G A <br /> N <br /> tY <br /> N O <br /> O <br /> 3 <br /> , ^^ <br /> : N <br /> W <br /> O <br /> Dzk', <br /> � <br /> � <br /> T <br /> 7] <br /> FYt'W 1'Cf M N L d to Z <br /> �V e1” SOr�t I O W gXa4 0 ytan - '- aF <br /> N -. C d - 4D <br /> w Zit Llwe 6 � m m <br /> l� m : m <br /> z o o' . u 7p <br /> An ' o O n ro <br /> di.Gl �6 Ka�o <br /> 9 . . ..... .. ...C... 9 ............ .......a/..� G....... - <br /> Si natur f Owner or A ent D to ° <br /> X M <br /> T <br /> Remarks ......................................................................................................................................................................... � Mp <br /> m . <br /> ..................................................................................................... . ... .............. .u .� <br /> o o <br /> MM Date ....................................... ... <br /> c <br /> ............. <br /> Zoning Admi trator......... g S 8 W <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facili �s <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 />