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Burnett County Office of Zoning Administrator c0 0 0Z <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 to ated as '� ~ <br /> shown herein, The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Li nd Use c :Z <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin 3 <br /> r <br /> !.c:..�i.R.r.. ...........11/1..L.. . . . R..k................... .., ..P... ...K....1...��. ".K .....C..oNsFt..... .......... ?S 'o <br /> OWNER (pleas_e fp}ri_nt) CONTRACTOR or SU RVEVOR or AGENT a m <br /> .................................... /.........h."a.PX36?............................. .......... <br /> ADPRESS ADDRESSI- <br /> 5o 15ht�.. . ..0 <br /> I <br /> ......................... .... .. sK .D. •. .... ..�.N...ti. R.y ... w.�a a. <br /> A RESS ADDRESS <br /> ..��....f7M.0.q.n....�R�.'. t..hf n� ................................................................. t ..... ........... <br /> PHONE PHONE ' <br /> .. .......... 6..6........ Y/f�....................................... , <br /> , -\,l <br /> ..i. . ............... <br /> ........................ .......... <br /> PLUMBER WELL DRILLER <br /> J ..................................................... <br /> ADDRESSADNA.I��Xf......................................................... ...I...... i� <br /> m C) :(6 <br /> . ...................................................................... <br /> PHONEPHON..E.......................................Y............................ .......... j' .: <br /> DESCRIPTION Ze <br /> 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathroomsla <br /> .......... <br /> o n <br /> New Buildingoms .......... <br /> Type of Construction: No. Bedro <br /> Addition C C jP:r�ttSeptic Tank Size Gals. <br /> Sanitary .......... Size .2...$..... ft. x . .�....... ftt'GRh .......... <br /> Filling/Grading4a. Absorption Field Site: <br /> .... Height..1.1...... Stories ...l.......... <br /> Moving .......... Area ..ri ..`.1.............................. Soil Type ......................... .......... 0 <br /> Mobile Home �I' Slope o <br /> Privy .......... 3. Use (describe exactly, 1 -family Fare. Rate ........................ .......... <br /> Well .......... home,garage, motel, etc.) Dry Wefl <br /> Subdivision Seepage Trench <br /> �...............I............ j� <br /> Privy <br /> Camping Unit ......... ��' .......... }�— <br /> ------------------------------------ ------ Seepage Bed ....... <br /> .. <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched In Fig. A. Incl, e road Q <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highw y inter- <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX STING 1— <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. a <br /> _____________._______------__ --- i 3 i <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ................................................................... .......... UY` <br /> t <br /> � NN <br /> no <br /> n <br /> O /461 LSF any' <br /> / v <br /> as N T <br /> toe <br /> Z <br /> d <br /> �- <br /> 7) <br /> y 7,7 0 r M -:Ew m Z <br /> c: <br /> w <br /> m <br /> _Ur a <br /> d, a m � <br /> CJ10 5 <br /> � � m <br /> gnat,re of Owner or Agent Date - <br /> X 31 <br /> Remarks <br /> m <br /> m � <br /> n <br /> .......................................................................................................... ... ................... . ....................................... ....... :�: <br /> Inspection Date ....................................... ....... .. .... ......,....... :........ f- o <br /> . ................................. . <br /> Zoning Adm istrator i�i $ $ $ $ $ <br /> NOTE: A preliminary site inspection must be made an 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 percolaho test must be attached to <br /> this application before a permit will be issued. Do riot purchase or install a septic tank, do any plttubing 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 Administiatoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE !AND APPROVED. <br />