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61%VeG27'ti <br /> Burnett County Office of Zoning Administ ator d o <br /> E <br /> ' APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> d <br /> TO THE ZCs If4G ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work 0 <br /> described and loc ted as •� <br /> shownXereln. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use m e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n i <br /> y�� 1 r' a O <br /> ....! �".Y...�/,... e •S . . . .......................................................................... V <br /> OWNER <br /> �(pleas eL9,tint) s CONTRACTOR or SURVEYOR or AGENT m <br /> ....GLC.tL.Y.�...U..Gl.r.. . . .... ...�...'....-MSV'... . . . <br /> Y . . ........ . . ..................................................................... ......... m '� <br /> ADD�ESS / ADDRESS <br /> 1s............................... <br /> ADDRESS ADDRESS <br /> PHO.................................................................................... .PHONE...................................................... ............... ......... <br /> ...t.d .P...fi.n..r. <br /> ........... . . . ....... . .. . ............................................................. ......... <br /> PLUM ER WELL DRILLER v <br /> ........................................................................................... <br /> ADDRESS ADDRESS <br /> m L1 <br /> K o <br /> c <br /> PHONE PHONE Z o <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms 1 <br /> 2. New Building Details •.••• ••• <br /> New Building Type of Construct'qt4 No. Bedrooms ......... 1° <br /> U <br /> m <br /> Addition „•,•. ... .......... .,y................. .... ..... „ Septic Tank Size Gals. ..,,r. <br /> SanitaryS <br /> „x,,, Size .............. ft. x ........ ft. <br /> rdc •V' h . <br /> Fillingl Grading ,,,,,,,, Height.. ......... Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .......................... . ....... c) <br /> ........................... ............ <br /> o <br /> Mobile Home ......... Slope ................................ ......... ^ .« <br /> Privy .......... 3. Use (describe exact) 1 -famil Perc. Rate ......................... ......... IIDJ <br /> Well •........ home,garage, motel, etc.) Dry Well ...... 3 :� <br /> Subdivision Seepage Trench ......... U i <br /> Camping Unit .......... .................................................... Privy <br /> ................................I................... .'ry <br /> Seepage Bed <br /> ----- ---------- --------------—--—— — <br /> - -—- -—----- —- Ik GU n <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Inaud, road •• - T <br /> setback, side and back yard dimension and location and setback from ail bodies of water_ If property is located at a highwa inter <br /> secfion, show the intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING i� 5 <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. -- I o' <br /> ------------------------------------—_—_----__—_------____._ -------- <br /> 5. Lot Size: Fig. A. 6. Location: � : <br /> ................ ft. x .............. ft. . ............................... sq. ft. :J!", ) <br /> 1 y-� <br /> 0 <br /> I 4 <br /> .0 o\ <br /> N <br /> v <br /> C.. <br /> M co r M m Z <br /> EA <br /> a < C 'a <br /> p v;' a T <br /> 0 0 0 a 70 <br /> 9So as <br /> ......... . ............. ... .................. . ..... ..... Co.-b.-.fib........ <br /> 0 <br /> Signature Owner//or Ag nt DatejX _ <br /> Remarks .... ....,...l.Y....� . . . . . . vrn <br /> m : <br /> ....................F.. ... t» <br /> . <br /> . ............................................. . <br /> . .. ...................... <br /> ...............(/ .L G y�.....�/.. ai ..... �r. ................ : <br /> c� / j.. .... .. ... .................. ..... . . <br /> Inspection Date ../.Q........{...`.r.lD... ........ .. .. C/. s?Ti.!{? .......................... ..... EQ u U o u o P m <br /> Zoning Ad nistrator u $ 8 S 8 8 ut <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 plu Bing 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 tl e Zoning Administratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ND APPROVED. <br />