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Burnett County Office of Zoning Administrator T 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as — <br /> 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use A c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> (JAM-9-9 O. PETEk,50N ........................ - V o <br /> ............................... . .......................................................................................... <br /> OWNER (please print) CONTRACTOR or.SURV EVOR or AGENT a <br /> ?K .eoAA ................................................................................. <br /> ADDRESS ADDRESS <br /> MAI <br /> ADDRESS ADDRESS ' <br /> PP..L..U...M..B..E..R.............................................................................. .....O.......................................................................................�2 �4 �6 ..... . . .. . ...... ... ..................... ....... ......................... ........................................ <br /> ADDRESS ADDRESS <br /> m LB <br /> o <br /> PHONE PHONE ' <br /> DESCRIPTION <br /> 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details <br /> No. Bathrooms .......... <br /> New euiidingType of Construction: No. Bedrooms <br /> Addition .,_ BL,CI,G; ¢;F,e,Q/�1E Septic Tank Size Gals. ......... <br /> Sanitary ........ Size , <br /> .......... Size .../..6..... ft. x ...... .... ft. ......... <br /> FillinglGrading ,,,,,,,,,, Height............. S les ..'J.�.......... 4a. Absorption Field Site: <br /> Moving .... Soil Type ................... <br /> ...... Area ....� .................... ................. <br /> Mobile Home .......... Slope ........................................ . <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... 7F <br /> Well .......... home,garage, motel, etc.) Dry Well ......... <br /> N <br /> Subdivision Seepage Trench .......... t <br /> F. .M.....Y.... f/-0.M ............. <br /> Camping Unit ......... T Q Privy <br /> QNCFA...lo.N.. ..?.M.... .......... <br /> •• Seepage Bed ......— yU Y^ <br /> 00 <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig A. Include 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- 1 a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 3 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: 0{, <br /> . ..0.... ft. x .............. ft. . ............................... sq. ft. o <br /> 2. /3 AG2E5 N <br /> C/VTX C N o. <br /> 0 <br /> h O <br /> W t o <br /> V) s <br /> 0 <br /> LAKE <br /> �7 n <br /> Qc << :E� m � c a <br /> E <br /> = m <br /> 0 0 0 a g <br /> �,+� <br /> �Gmr� �% 8-.5�5— �t p <br /> gnature of Qwner or Agent Date <br /> o C <br /> S� x z <br /> Remarks ....:GC/.. ?r.'� �..".....y.r.Z., ................................................................................................................. �t m <br /> � O <br /> ...............................................................................................................................................................................I........ <br /> u <br /> ......................................................................................................... <br /> / <br /> Inspection Date ....................................... ... ...........D.... ....f. .� <br /> ......... Nm <br /> ..................... <br /> m <br /> Zoning Administrator i $ $ $ $ $ $ y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f d C I I itieS <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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />