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Burnett County Office of Zoning Administra it <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 ind # {� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the n c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regu let ions of t he State of Wisconsi n. _ <br /> 1���G ....G. i��1 .Z/r0.. .Is......... ............... ... <br /> a <br /> >" m <br /> e <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> ...................................... ...................... kIZI`........................ Or n <br /> ADDRESS ADDRESS t , <br /> lit. ! ..... .L� .....�!1�... .. Y.oa. .. ..................................................................................... ...... <br /> ADDRESS ADDRESS <br /> ..............7���..:. 5...-��?�a .,!`........................... . . . . . . <br /> PHONE PHONE I :� <br /> R...t .p.k .z. ......................................................... . ................................................................................... ...... <br /> PLUMBER WELL DRILLER <br /> .......................................... ...... <br /> ........................................................................................... . . ...................... ............ O <br /> AOORESS AD.. ..DRESS is n O <br /> < ,-N <br /> .. ........................................................................................ ..................................................................................... ...... O <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: l ° ° i0 <br /> Bathrooms <br /> 1. Work: 2. New Building Details No. <br /> Now Building ,,.,X„ Type of Construction: No. Bedrooms ... ...... <br /> Addition •••• ........... Septic Tank Size Gals. ...... ;� C <br /> Sanitary 2�.... Size ... .y..... ft. x ...;3..: .... ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Type ............................ i <br /> Moving .......... Area ........................................... Soil Typ ....... r O <br /> Mobile Home Slope .................................. ....... in <br /> . ... . i+ <br /> Privy \. . 3. Use (describe exactly 1 -family Parc. Rate ........................... ....... 0 <br /> Well .,,,,, home,garage,motel, et . Dry Well .... <br /> Subdivision <br /> Seepage Trench Z 'H <br /> Camping UnitPrivy <br /> .......... ^' <br /> ................................................... <br /> Seepage Bed � .......7 _ I �-- : <br /> -------------------------------------------------- — <br /> --- -- -- rn <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fill. A. c <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. v<-, <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. _ : I :fes 0 <br /> 5. 3 kA <br /> Lot Size: ig� 6. Location: <br /> � � <br /> f ./ 1 _ <br /> t <br /> e <br /> o <br /> u � J <br /> o <br /> e <aj i <br /> �� '.L �✓ ��� i��� 'A� t'A5 0 <br /> ri <br /> l V m pp <br /> Z <br /> 0 <br /> d <br /> I <br /> I r� —� rnvrnrW my <br /> M c . m m o O c c <br /> i n wa < J Jo . rn <br /> T _ %� <br /> I i" <br /> O < d C y J J <br /> O D <br /> 1 oiiJ Nn <br /> D 0 : m <br /> nom ' o <br /> � J . <br /> v... .. ................................ ..... .... �..:: ......X......... <br /> Signature of Ow/n/er or Agent Date o <br /> Remarks1..(. ......-d'Z.`'�..-........................................................................................................................ ' <br /> I�t... UtLt. <br /> ..........................................` <br /> o . . . o <br /> � ;'- ... .. '.. ...... .....................................Inspection Date a. ............ N o N <br /> Zoning Administrator <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f cilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has bec n issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ANDA PROVED. <br />