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Burnett County Office of Zoning Administrator z <br /> 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 /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> IF <br /> OWN/ER�((plea1sg print)�p� CONTRACTOR or SURVEYOR or AGENT a I <br /> (N../.l.cl..�...a /..... <br /> ` ... ............................................................................................ a ;Q <br /> ADE ^ ADDRESS <br /> ..-s f ................................... . ..........................................................................................ADDRESS <br /> ADDRESSO <br /> ........................................................................................... <br /> PHONE .PHO......NE....... <br /> ....... <br /> .............. <br /> ........................................................ :J <br /> ....................r.................................................................... . . ..................................................................................... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... \c <br /> ADDRESS .ADD.. ..RESS.. .................................................................................... O <br /> — \ <br /> n O <br /> » < <br /> PHONEPHON..E................................................................................ �Z o <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathroo .......... �° <br /> New Building ,......... Type of C truction: No. Bed .......... <br /> Addition V ............ �u;� -� Septic Ta a al .......... :� < <br /> ./V.... . .L'y ......... .. <br /> Sanitary .......... Size .J .. ft. x .C74:0. ft. .......... <br /> FillingtGrading ......... Height............. Stories ....f....... 4a. Absorption Field Site: <br /> Moving .... ..... Area Soil T/e / <br /> Mobile Home ........ . SIoPe ... ................... » <br /> o <br /> Privy .......... 3. Use (describe exactly,-1 -family Perc. ................ <br /> We1i ho aragem��ote� l, etc.) Dry W .......... <br /> Subdivision .......... �"-f/t""`-�1'� Seepah .......... I <br /> Camping Unit „ ,,,,,.,, Privy ,,,,,,,,,, _ <br /> ------------ <br /> Seepage Bed .......... <br /> ------------------------ t <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc, should be sketched in Fig A. Include road I[> <br /> M <br /> Setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Inter- i a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING (� 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> O o <br /> _____________ <br /> 5. Lot/Size: ,�ryx30 z Fig. A. 6. Location: <br /> v. ft <br /> ...�{J✓..... ft. x ci .. ... ................ sq. ft. ............II <br /> a <br /> N <br /> m <br /> O <br /> O � � <br /> O <br /> p <br /> Z <br /> 0 <br /> See gtfaJ�el sk k)-h <br /> N� "� �'CP�CtLC-Mer--I p� �� pn.t�w OhJ WBa.! ll.oud2, i <br /> CT Er :” m z a Q a � m EL f <br /> N —. C w W <br /> U � . � �� R¢mU Li.� �jMofS • m : m <br /> Z 00 D a <br /> ?9,Dcr� ...........- � p <br /> . .Agent Datee o <br /> Remarks ......................................................................................................................................................................... X M <br /> T m <br /> ............................................................................................................................................................................ 09 ' <br /> ................................................................................................... ... <br /> II <br /> ..................... <br /> Inspection Date ....................................... ��/�� N ro mp1t <br /> m <br /> °: u � ovm <br /> Zo g Administrator �? 8 8 S S rn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all Structures Involving sanitary foci, <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attache <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 he made without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />