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Burrtbtt County Office of Zoning Administr for -g4 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> ^ M <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulationsof the Stateof Wisconsin <br /> /� / <br /> o rT�, �'c o-�yT /{ 0 it - <br /> 42.t <br /> WNER (please print) � �c- �t -- V _ � CONTRACTOR or SWRVEV OR or AGENT •� S. <br /> �.Q. .....j.. ..°............................................................... ..................................................................................... ...... <br /> ADDR€SS ADDRESS <br /> z ......... ?'h.. -...................................... . . . .............................................................................. ....... <br /> yj[( .......... � ` <br /> ADDRESS ' ADDRESS iSO ; I — <br /> ..................................... .................................................................................... ....... <br /> ` '~ ` <br /> PE ........................................................ PHONE <br /> PLUMBER WELL DRILLER `y i` <br /> O <br /> ADDRESS ADDRESS n o C' <br /> ^ <br /> ........................................................................................... . ................................................. ............................... ....... O 1" <br /> r To <br /> PHONE PHONE Z ,e r-�� <br /> DESCRIPTION 4. SanitaryFacilities: B "' <br /> No. Bathrooms '- <br /> 1. Work: 2. New Building Details " " "" is 'o ' <br /> L� No. Bedrooms <br /> New Building Type of Construction: tS� <br /> Septic Tank Size Gals.Addition <br /> v E <br /> Sanitary ...4..... Size ...?.j..... ft. x . ........... ft. a"" <br /> Filling/Grading g i 4a. Absorption Field Site: ( r"3 <br /> ......... Height............. Stories ............... <br /> g Soil Type ............................ ....... ; <br /> Moving .......... Area .............. .... . . ............... 6 <br /> Mobilo Home l0r ^,`U ' ..... . Slope ................................. ....... -V .. <br /> .......... t/r� f..� <br /> Privy .......... 3. Use (describe exact) -fami Perc. Rate .......................... ........ 2 <br /> Dry Well <br /> Well ..,,,,.... home,garage, motel, •) Seepage Trench o <br /> 1 C . ........ <br /> Subdivision .......... ....�...�."'.1M,1�..... . eiG Privy . ........ .jJ7 ' <br /> Camping Unit .......... / ' <br /> .................................................... Seepage Bed <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketchedn Fi . A. `,� Cr <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property isioco ed at �:j <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. - <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. r t <br /> ___ ________________ ____ <br /> 5. Lot Size: Fig. A. 6. Location: :SC• <br /> ................ ft. x .............. ft. — ............................... sq. ft. ..................................................................... ......... <br /> N O <br /> / J <br /> ��3 3 (a <br /> �ro-O K 19 pal-K, M/J <br /> T <br /> Z C <br /> O <br /> 9 <br /> d <br /> M <br /> M <br /> W <br /> S'D 02 w <br /> ZOO "7D 1 <br /> a : S <br /> moo : m <br /> pp a `= 0 . O <br /> ...•t•�... ...... .................... . .... ............ ......... <br /> A <br /> Signature o caner or Agent Dat........ ..e $ <br /> Remarks m <br /> N <br /> ................................................................................................................................................................................. ...... <br /> lkl dnnt <br /> s <br /> $ b <br /> m <br /> Inspection Date ....................................... <br /> �Atrator <br /> o <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this ap lication 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 been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans o 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 />