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Burnett County Office of Zoning Administratora o Z <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 o :U� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> ����'�� < S ALF <br /> oo.. ......... ........................ . . ........................................................................................ <br /> OWNER (Please print) ,p CONTRACTOR or SURVEYOR or AGENT a <br /> ................-Z........................ <br /> . .......................................................................................... <br /> ADDRESSrli <br /> ADDRESS � <br /> 1............... <br /> .......................................................................................... <br /> ADDRESS ADDRESS <br /> ........... 635- 850 € <br /> .. <br /> PHONE PHONE <br /> ........................................................................................... . .......................................................................................... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... . .......................................................................................... <br /> ADDRESS ADDRESS G <br /> 0 o <br /> . . .................................................................... .PHONE................................................................................ <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o c <br /> 1. Work: <br /> 2No. Bathrooms <br /> . New Building Details <br /> New Building Type of Construction: No. Bedrooms .......... a <br /> M <br /> Addition .. ., Septic Tank Size Gals. .......... <br /> Sanitary Size ..� 7.... ft. x ./.... .... ft. .........• I <br /> Killing/Grading .......... Height ty. .. Stories ...0........ 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... !' <br /> ........................................... o <br /> r <br /> o <br /> Mobile Home .......... Slope .....................................:. .... 3 .+ <br /> Privy .......... 3. Use (describe exactly, -Tamil Perc. Rate ........................ .. ...... <br /> P <br /> Well ho e,garage, motel, etc.) Dry Well .......... 7 <br /> .......... <br /> Subdivision .....•,,,, ,�Dy,� Seepage Trench <br /> ... ....... .......... ....... .. <br /> Camping Unit ,,,,,_•,,, Priv . <br /> Seepage Bed .......... ti i <br /> ---------------------------- -------_---------------_— 'CN <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road t 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- W or <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING S <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. N o� <br /> ------------------------------- <br /> 5. Lo iz <br /> J� fy n�O Fig. A. 6. Location: o <br /> .............. ft. x .............. ft. — ............................... sq.ft. ............................................................................... w <br /> O P <br /> � N <br /> N <br /> O <br /> O <br /> ✓< <br /> -- <br /> /+ems P ---� C �� /_ <br /> 1q,0,01 d1l) <br /> jD <br /> Z <br /> o <br /> m <br /> \ A�� i0 <br /> sF0 _ z <br /> - 1 \ ooc m » m <br /> / �nt EA o. M :E w <br /> C.� � m n tom <br /> o <br /> m <br /> .......... .... ..... .. o C <br /> Signa u of�1Agent Date _ <br /> , lO ..........Remarks 4: - <br /> ..... ....................... -.... ........... .... ..............,, ................. .. <br /> m <br /> .y........... <br /> M . <br /> ............................................................................................................................................................................... <br /> .................................. <br /> d : <br /> oD <br /> InspectionDate ....................................... .. .. . .... ....:...................... .?Z<......................... : : u "61 m <br /> Zoning Adrrohistrator Xj $ $ $ $ $ $ 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 We made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />