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L next County Office of Zoning Administrator Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describedand located as '� ~ D. <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordiruance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> ........�..... .�?t . . .. — <br /> .��..� se <br /> OWNE I leasee F <br /> (/1S � CONTRACTOR or SURVEYOR or AGENT m i� <br /> �e ...............................7...-................................. a <br /> ADDRESS <br /> .,y� ///� I ............................................................................................ a <br /> S*c f"Al- ADDRESS <br /> n r <br /> ADDRESSADDRESS............................................................................ 'U <br /> ................................................. .......................................... <br /> PHONE . . <br /> PH..ONE....................................................................................... <br /> :J <br /> ........................................................................................... <br /> PLUMBER . .......................................................................................... <br /> WELL DRILLER <br /> ........................................................................................... <br /> O <br /> ADDRESS . ................................................................................ � m � <br /> ... ...... . <br /> ADDRESS a, <br /> ,n+ o <br /> ............. . . . .................................. P.................................... . H..ONE...................................................... .......... <br /> ........... ....�....... o M <br /> PHONE � <br /> DESCRIPTION Z '" r <br /> 4. Sanitary Facilities: o o <br /> 1. Work: 2. New Building Details No. Bathrooms ......... I M <br /> New Building o <br /> .. ....... Type of Construction: No. Bedrooms .......... a <br /> Addition ...... 4" Septic Tank Size Gals. .......... <br /> Sanitary Size .s`r.;.�P....... ft. X .. ..Y.... ft. .......... <br /> PnlingfGrading ......• Height............ Stories ............... 4a. Absorption Field Site: ?p <br /> Moving .......... Area ............'73il .. ... . .. Soil Type .................................. . .to <br /> J r <br /> Mobile Home ,•,•• • V O <br /> Slope ............................ ....I........ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .. ................................ <br /> Well horjgaragemoteletc ) Dry Well „......•• � C E <br /> .......... , , , etc.) h <br /> Subdivision 7 e Seepage Trench .......... :C <br /> .......... <br /> tt. <br /> Camping Unit .......... Privy .......... <br /> ...........................................I. ...... ; <br /> ____—_—_ Seepage Bed t <br /> Location of proposed structures and existing structures well,sewage systems, roads etc.,should be sketched m Fig. A. Include road � .A •� <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter 5j :D a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5 <br /> N, <br /> ______________________________________________________________________ I, o <br /> 5. Lo �� _ Fig. A. 6. Location: <br /> . ... ... ft. x¢'�.�.. ft.. — O.J,t�6C1.*. .... sq.ft. ... .:r. ...:5 ?�i•r+c�l":r^P,-' f1`i ('/� <br /> O i t <br /> rrn <br /> sP <br /> �] !+ M <br /> IV <br /> o � - <br /> m <br /> o `6` <br /> SPC � tiG <br /> OZ <br /> O <br /> d <br /> _ <br /> m <br /> V(r`{ <br /> W Z <br /> ry FIF <br /> C 4 C N <br /> ��Zyy CIO <br /> p ai <br /> Cie = o m <br /> Si ature oCf Owner or Agent Date C: <br /> Remarks ......................................................................................................................................................................... X : T <br /> M rn <br /> M <br /> ............................................................................................................ FA <br /> ........................................................................................................... . .... ... <br /> ........ .. .... ............................................... u <br /> Inspection Date ......................... ............. m <br /> "....f .�...... ............— U N tT N <br /> Zoni g Administrator inistrator E `: g g g ' g y <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 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 />