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Burnett County Office of Zoning Administrator W "f <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described land <br /> locatedq i <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the r� <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws land S ( „ <br /> regulations of the State of Wisconsin. <br /> .. . ?h. . />1.... <. �.g4............... L..... <br /> OWNER (please grin CONTRACTOR or SURVEYOR or AGENT [ , <br /> �a. . Nd�O.IY ......... �!4......... .....................................................................................G...... d <br /> ADDRESS / v1� ADDRESS <br /> .....S 14.. u.l..............1.�.!.. ..................................................................................... . <br /> ADDRESS ADDRESS <br /> T..................... ..................................................................................... ...... <br /> PHONE PHONE <br /> 1 <br /> ........................................................................................... .WEL........L D.....R...ILLE.. R.. ...............................................................�h...... :C <br /> PLUMBER <br /> O_ <br /> ADDRESS ADDRESSd <br /> o........................................................................................... . ............................................................................I....... O <br /> PHONE PHON........E i Z <br /> DESCRIPTION 4. Sanitary Facilities: I P S <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ••• � c <br /> New Building ....7.F... Typ of Constructio No. Bedrooms <br /> Addition ...,.,,,,. Septic Tank Size Gals. �.. ' <br /> Sanitary .. ... Size ....ojl..r ft. x ...IGP.,7.'... ft. �Q.•r.C.. <br /> Filling/Grading .......... Height............. Stories ..... 4a. Absorption Field Site: <br /> Moving .......... Area .....l...7...Q, ...u.,/E.u��>� Soil Type ............................1....... E \ r <br /> Mobile Home Slope .......................................... <br /> Privy .......... 3. Use (describe exactly,'1 •family Perc. Rate ............ ..............�....... p <br /> Well home,garage,motel, etc.) Dry Well ....... m <br /> Subdivlalon Seepage Trench .. ....... <br /> Camping Unit .......... t�4/�lfr.....f�/4t1G'.✓.•x'•!fi�' Privy �{ y� <br /> .... .. Seepage Bed /OF iv <br /> -------------------------------- --------------------- <br /> ------------ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. v` ` <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. 5. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ___________________________________________________________________ __ <br /> 5. Lot Size: Fig. A. 6. Location: j <br /> ................ ft. x .............. ft. — sq.ft. ...................................................................... ....... <br /> S�� 0 <br /> i o <br /> m <br /> J/�,Irf. <br /> '` I y <br /> • m <br /> I m <br /> ?4 ?3�� <br /> X m V N r > W dJ -0 <br /> n N a < > j m <br /> i <br /> ' m a� a m a a y <br /> <. Z^o � � D <br /> o _ N n <br /> o � » m <br /> o f 0 <br /> ' — <br /> ..... ..... ................ ...... ......... x �� <br /> Signatu of Owner or Agent Date <br /> Remarks �� m E <br /> m . <br /> %bJJ ... ..'.J.....� ..�...1.............................................................................................._...............'�............. <br /> ............../.. �.....?%Z.f ... <br /> ........................................................................................................ ...... ................. . ....................... <br /> Inspection Date <br /> 7...,,.7..11.... ..... <br /> T <br /> Zoning inrstrator g o 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary failities before con"truction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appli ation before a mit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has bee issued. A permldmay be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or pecifications sl not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP (ROVED. <br />