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- ..�Y'J7 L 1•y"�p <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. 3 <br /> 0 7 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m m Q ;� <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> a iA <br /> J.e,41 ...................................... .... f: n.K......... arl .. .................................. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AG/BNT <br /> + ... ........... .......................... v m <br /> ADDRESS <br /> ADDRESS <br /> .�.C. ....{.....�♦fJ� s:ce c si �.......S�S3 rzz,� {. ... .........................................C ✓ q? , .... <br /> / , <br /> ADDRESS (�. y/ (�],f� ADDRESS r"�' Q� <br /> Z .�.. .!..a. ......... :.....`.,��.- .T.''...-.......... .PHONE...... ... ....yL..OV..................................... <br /> PHONE !V�J <br /> �.�5.........�0er� ...................................... ............................................................................................ 'o <br /> PLUMBER WELL DRILLER <br /> F-.... .....w.�s:............................ .......... ................................................................................. , <br /> ADDRESS ADDRESS :� » 0 <br /> 6............a................................................. ............................................................................................ <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 ° <br /> 1. Work: yy 2. New Building Details No. Bathrooms ... i� o <br /> New Building „r,`,,,, Type of Construe_tl'pn: No. Bedrooms .. .... <br /> Addition =fVG..+t Septic Tank Size Gals. IQ-0;� r p N <br /> �..... ....... .... .......... : '• <br /> Sanitary . ..., Sizec...�......... ft. x .rt6...... ft. <br /> Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ............... Soil Type ........ . ? : o <br /> ............................ <br /> Mobile Home Slope ..........Z.....Q...... .............. .. <br /> Privy ,,........ 3. Ups -.((describe exact , 1 -famil Perc. Rate ........�.3.' <br /> Well ,garage, motel,etc. Dry Well .......... A ti <br /> lv6 <br /> Subdivision .......... ,d!a„D£ck,,,a rz„ton RC H..q,r Seepage Trench .......... )a '0 <br /> Camping Unit .......... snr trm, Privy .... o <br /> Privy t <br /> Seepage Bed . ..... <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road J iQ Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING v <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. °� o <br /> --------------------------------------------------------------------- k <br /> 5. Lot�,S$7[ize: Fig. A. 6. Location: o 'Q'-' k'•1 <br /> P�d�y../.7.y.. ft. , / ft. — ............................... sq.ft. ............................................................................... n ^ <br /> N W_ O <br /> Wdl ��c1sh � <br /> mrJ <br /> Fc <br /> m N <br /> � m <br /> €G <br /> � cnry wm <br /> n Q < m 7 c m <br /> _ _ E <br /> -o aia C� m S m <br /> oV;W am <br /> Z o0 <br /> IImo Im <br /> Signature of Owner or AgentDate <br /> X <br /> Remarks ......................................................................................................................................................................... m . . . . m <br /> v <br /> ' <br /> �� II <br /> ............................................................................................................ .. ... . ....................... <br /> ......................................... <br /> 0 <br /> Inspection Date ....................................... �r� . ..... .................. Ig G' U o o m <br /> Zor ministrator 8 8 8 8 8 8 m <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 />