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Burnett County Office of Zoning Administrator a 75' 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as m 0 <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 Cade, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> a <br /> .h.... .....8:.....8/ 1rc h. .a..r...�......... ......................-�.,4.f................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. m <br /> ....................................... ................................................................................. .......... <br /> ADDRESS S ADDRESS •I? <br /> A�`.�r.E4K..L�..✓. /.C..:.. .........zTj.L..�G. . ................................................................. .......... <br /> ADDRESS <br /> g .... .'7 o...5-!.F......................... <br /> PHONE PHONE �J ' <br /> I <br /> ........................................................................................... . <br /> WELL DRI <br /> . . .LLE........................................................... .......... ` <br /> PLUMBER R <br /> v : <br /> O T <br /> ADDRESS ADDRESS mt7 'a <br /> n O <br /> ........................................................................................... ................................................................................. .......... <br /> PHONE PHONE Z <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms ' <br /> 2. New Building Details ••'•'r"" � - � ' <br /> New Building ,.,.,,. Type of Construction: No. Bedrooms <br /> Addition .,..,, = Septic Tank Size Gals. . .. I <br /> Sanitary .......... Size ..../a.... ft. x ..... .. ft. .......... <br /> Filling/Grading .....,,... Height............. Stories ....L......... 4a. Absorption Field Site: <br /> Moving .......... Area ........./..44.4.... ` ..... Soil Type ......................... .......... m <br /> Mobile Home . Slope ............................... .......... o <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................ .......... <br /> Dry Well ' : (I ' <br /> Well ...... home,garage, motel, etc.) ""'"' <br /> Subdivision7. ce Seepage Trench .......... <br /> Camping Unit .......... ..... .:(,Lse — Privy .......... <br /> . ......................... <br /> Seepage a e Bed <br /> ------------------------- ----------------------------- -- cn' <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched In Fig_ A. Inclu e road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highw,y Inter- Q <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX STING v <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS.---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: ' <br /> y �j <br /> ... ft. x -6mia.. ft. - ....�..7400.P.... sq.ft. 1...G.yt1^��.T.F. <br /> ra c z/✓ ,-4 5(f Y fY uri'' N <br /> 0 <br /> o <br /> aV <br /> o <br /> 1 � <br /> A('. ? ' <br /> r <br /> /1'o, <br /> i r <br /> M N r v �E m m Z <br /> 0 act <br /> �S7 0 o nn z <br /> . .-rC.i � !h.. .... .�.�.. ...... vt — <br /> x <br /> � rr <br /> , <br /> G <br /> Signat e of fgevn+er or Agent Date o C <br /> S <br /> Remarks ................................................................................................................................................................ ........ r m <br /> � E C <br /> e» ' <br /> n <br /> . uNi r^sil o � rT <br /> H <br /> InspectionDate ....................................... .. . .... ..... .... . ..9 .. ...................................... � <br /> p Zonin A ministrator 8 8 8 818 U <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 percolatiol test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any pl imbing or start any build <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the ir formation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of he Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />