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Burnett County Office of Zoning Administrator lati o I/o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ; 3. o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < N :G <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. 3 a <br /> 7n <br /> .C�Ll1 :./. .......... ...(r. L/f' ..... ..............:.—'47;.`1......../......1� o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> ................. ..... .' ................................. ` ....`. / ..... .......................... a <br /> ADDRESS ADDRESS <br /> ..... . . . .... !7.<�W.1.7�r'./! .�,.. ....................:/� .. tr`!fJ...�c'/.4::✓............................... � <br /> ...................................... <br /> ADDRESS ADDRESS <br /> PHONE.............................................................................— .PHONE....... ..... .............................. <br /> fF..:...T....rF'. / S/.../..... 'V1 <br /> ......PLUMBER R WELL...... �fG:. ........................................................ . . ....DRI <br /> ............LLER..................................................................... :u , <br /> p <br /> ADDRESS ADDRESS 0 0 <br /> ........................................................................................... ..... 'N'E–....................................... ....................................... <br /> PHONE PHO. NE Z r <br /> DESCRIPTION 4. SanitaryFacilities: 0 8 0 :\ <br /> 1. Work: 2. New Building Details No. Bathrooms ......�. ' <br /> New Building .......... Type of tryctiQn: No. Bedrooms .......... <br /> Addition f F Septic Tank Size Gals. .......... rC� <br /> ..VIC- ......... ......E.:............................ .. <br /> Sanitary .......... Size .............. ft. x ft. """"" <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> .......... Area .......................................... Soil Type ..................... ............ <br /> Moving <br /> o <br /> Mobile Home . . Slope .......................................... <br /> ...... . <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... 9�_l <br /> Well <br /> Wei <br /> Wau ,..,.,..,, home,ga age, motel, etc.) Dry <br /> subdivision ;j-i? Seepage Trench .......... ,l <br /> Camping Unit ... �...... <br /> .... Privy .......... J� <br /> ... � ,.....�. �..} pp. <br /> P9 .......... ....4 -M..W,,.... i <br /> �y Seepage Bed \ <br /> Location of proposed structures and existing structures, well,, sew�ageSystems, roads,etc., should be sketched in Fig. A- Include road /J o � <br /> 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- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING Fi a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �tJ <br /> ----------------------------------------- — __—_— _ c :f <br /> 5. Lot Size: Fig. A. 6. Location: i *n <br /> k <br /> ................ ft. x .............. ft. — ............................... sq.ft. .................................................... ........................ v <br /> / r N pOw, <br /> 3 <br /> sf Rc �r� $ <br /> xk <br /> T <br /> 0 <br /> -- ' o <br /> I � <br /> N r 9 rn 2 <br /> c c m <br /> N n C'< N 5 c � <br /> a n < n <br /> m : -. m <br /> Z O o <br /> o <br /> Ise _ <br /> ..... � .. ............ ..Yi�l../� ........ o <br /> Si ure of in or Agent // Date — <br /> �1A i x rb i <br /> Remarks .>�.�1�...E"�t�:1. .�#... .......................................................................................................... � ; � m <br /> oa <br /> ........................................................................................................................................................................................ II <br /> C <br /> ....................................................................................................... .. . . <br /> . . / � �Gl T <br /> . . .......... ....................... ........ .......................... <br /> Inspection Date 1$ b <br /> ,ux'ruo No � rmfl <br /> Zoning Administ for %�✓ g g S o g g N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faciliticS <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 />