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Burnett County Office of Zoning Administratord 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 �\ <br /> o <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 ntY Land Use � Ne <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> Ni6v". ............... ................ <br /> F. ....................................... <br /> ......... ....... . <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT m im <br /> .1L''3.9.... Asn .............................................. . .......................................................................................... a <br /> ADDRESS ^ ADDRESS <br /> ................... ................ [ � <br /> ADDRESS <br /> . .. .. ADDRESS <br /> ............ ....................... . ......... .......... . ...................................... <br /> ......... <br /> PHONE ".. \ eai7T: <br /> .. . r .. . .. . . <br /> \ <br /> J <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS.................................................................. o 0 <br /> tGl..-:..3. ................................. ._............. .......... Z <br /> PHONE ..... PHONE t 1 <br /> DESCRIPTION 4. Sanitary Facilities: o ° <br /> 1. Work: 2. New Building Details No. Bathrooms �.....�.... <br /> rt o <br /> New Building ...,..,,,, Type of Construction: No. Bedrooms ....0.1... i� 'c :.. <br /> m <br /> Addition .... Septic Tank Size Gals. <br /> Sanitary .... Size .............. ft. x .............. ft. <br /> Filling/GradingHei ht............. Stories ............... 4a. Absorption Field Site: ! i <br /> .......... 9 <br /> Moving .......... Area . . . .. .. ............... Type � T� !.......... : o <br /> ............... . .. / c <br /> Mobile Home ... ...... Slope ....................../.. <br /> Priv Pere. Rate ................... ........... <br /> Privy .......... 3. Use (describe exactly, i -famil <br /> Well ........., home garage, motel, etc.) Dry Well .......... ;(\�\ i <br /> Subdivision Seepage Trench R' <br /> D 9 .......... Priv <br /> --Cam in — --___-------------___.—.-i.r. ----✓— _-.__--v---__—__--.__-___— <br /> Seepage Bed /% -,2--2 <br /> N <br /> Location of proposed Structures' and existing Structures, we'.I, sewage systems, roads, etc., sh ou Id be, sketched in Fig. A. IncIfeie road � !� cr <br /> setback side and back yard dimension and location and setback from all bodies of water. If prrrperjs s located at a highvraN inter- 0 °- <br /> section, show the intersecting highways antl the setbacks rebu.red along t'. em and at the intersection CLEARLY LABEL EXISTING I < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ' -L ° <br /> -- __.__--- ----- -_..-_. - ----.-._ ----- ----- ----- ___. _ . <br /> O <br /> 5. Lot Size: iq Fig. A. 6. Location: <br /> �A/�L.. = C <br /> p{ .o : <br /> ...aZ 1U..... ft. x . ... .. ..... ft. — ............................... sq.ft. ........................................ ........'..................,.......... G : y <br /> „ N <br /> 5ee�crr•t�s I a OY�� <br /> 6- IJt� 1 <br /> 113('/~ <br /> 7d '� ° <br /> 73 <br /> T <br /> Sc� �V-u 6--1 z <br /> JJ <br /> N <br /> 9 N r T 0Z <br /> < <br /> EA <br /> n c c m a - - f <br /> m a <br /> 'o� tNir c� C <br /> - 1 - m <br /> O <br /> z oo a 77 <br /> Fn . 3» - <br /> m <br /> txt'� <br /> .................. .. .......:....... r: <br /> Signature of Owner or ent ate ..•TTT"' — <br /> /� <br /> ..lC..'./.�... .. .... /~........... ....................... ..... .........................._ ........ ....... <br /> � X <br /> Remarks m <br /> / <br /> . ...4 ....... ................. <br /> Inspection Date ....L...:':'..�...7..vE....... ........ ... -�Zonjngd�mini�sit�rat <br /> E u�r U 'o N o U m <br /> or �I 8 0 0 0 0 0 to <br /> V <br /> NOTE: A preliminary site inspection most be made and site approval granted on all structures Involving sanitary facllit ius <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 riot 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 on srepresentation 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 Zonlnq Arlon inistiatot . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />