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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT - 3 � <br /> O O <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use as <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> 8 — <br /> tt Co7vIvo ft - <br /> ......... . ............................................................. c. <br /> 0 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> Em <br /> ... ..... ........... ........ ...... .... . .... .... <br /> ...................... . .... .. .. . . . . .. . . ....DR.....ES................................................................................ <br /> ADDRESS /�/ ADS 'r, <br /> .......... <br /> ............................................................................ ..A..DD........S................................................................... <br /> ... <br /> ADDRESS RES <br /> ............ <br /> ........................................................................................... ................................................................................ X11 <br /> PHONE PHONE <br /> ............... .......... .. .................... .. ............... ........f .4.f1'-4 Ns. ............°........................... <br /> PLUMBE _ /-} ` (. WELL DRILLER \14 <br /> Ili <br /> ADDRESS ADDRESS <br /> 3 �/ 5 r x....... .�fi.c....Q>x..� . .................. .. .....�.. ........1/x .................. ... z o <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Fecilities: ° o <br /> is v <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> . <br /> New Building .......... Type of Construction: No. Bedrooms . ... ;? o <br /> p o_ <br /> Addition .................................................... Septic Tank Size Gals. �..p.Q... <br /> Sanitary l%' ..�'^.. Size ft. % ft. ....."" J�� <br /> FillinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type:... -—.................... (v'� .o <br /> ........................................... q t\y <br /> Mobile Home .......... Slope .....[6a...r..........A..&. g..... : .* p <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ./ -.f, .�..l.7...,...... <br /> .......... p <br /> Well fr .. ':. home,garage, motel, etc.) Dry Well <br /> Subdivision <br /> Seepage Trench �.... ;P <br /> .......... ............................................ .�. <br /> Camping UnitPrivy .......... DJ <br /> ---------------------------------- Seepage Bed-------- 71 ?� <br /> N <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should he sketched in Fi - A. III i Q <br /> g <br /> setback, side and back yard dimension and location and setback from all bodies of water. I1 property is located at a highway inter- O- <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. !'yam _ O <br /> 5. Lot Size: - O() Fig. A. 6. Location: <br /> L.G.y....... ft. x /.0.at..... ft. . ............................... sq. ft. �............. .. <br /> 0 <br /> sOlt <br /> ° <br /> vl <br /> b ° <br /> 5o <br /> / 0 <br /> �°fo <br /> 0 <br /> i� as <br /> C d d C N <br /> tA <br /> µ� Z Oo � D n 7J <br /> . [ ' -I <br /> ��V^ \a <br /> / . ° <br /> Signature of. Ogw.qne//r or gent , Date ? X <br /> Remarks ... . . ....a?�"`..... .'.J�. .... T <br /> �/ n <br /> ................................................................ <br /> ...!?... ...... ... ............. .......................................... ..c......... Administrator...................... c o"o : T <br /> p ... ry ..... .. .. cp -in'Italy ofo \oam <br /> Inspection Date - b c//�L` ... . . o: C' <br /> Wooer <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving S, y �c ill[res <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must he attacher) 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 /> �mtil a permit has been Issued, A permit may be revoked if misrepresentation of any of the information conveyed here <br /> -md to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> ,YSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />