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Burnett County - Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o t 1 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N µ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and re ulations of the State of Wisconsin. 3 <br /> c✓ . . .. ....c7frc E.rt/S .............. ....s l :.......... .......... �c A y f <br /> OWNERFig,lease print) � CONTRACTOR or SU RVEVORor GENT a - <br /> ���/...✓ ...�ii.. M� .. .................... .......................................... 1 ........... d / <br /> ADD, SSADDRESS <br /> IS.CI ...f11�S(..:.....�1. -.z:L. '....... ................ e./7.f1..� �....... <br /> ................................ . ' <br /> ADDRES ADDRESS <br /> -......lZ.-... �...7..�.�..�............................ <br /> ........................r-.. .s.. .....33, <br /> PHONE PHONE ice, iar' <br /> ................................................................... ..................................... ................................................. <br /> PLUMBER WELL DRILLER o<,11 <br /> ° �: <br /> ADDRESS ADDRESS m <br /> ti a 0 <br /> ��. �x <br /> ........................................................................................... ............................................................................................ 5 <br /> PHONE PHONE Z ° r _ <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 h <br /> B <br /> 1. Work: 2. New Building Details No. Bathrooms I- <br /> """"" 0 1�1 i <br /> New aulltling ,...,-,.., Type of Construction: No. Bedrooms .......... $ <br /> ✓ e GI' � Septic Tank Size Gals. .......... <br /> Addition p <br /> .......... ....&......�.. ...............,,/.l..... .... .. <br /> Sanitary .......... Size ...(.7rr.�... ft. x ..aa.0.... ft. """"" 3 <br /> Filling/Grading .......... Height.,e... . St0 4a. Absorption Field Site: -i <br /> ... .......... <br /> Soil <br /> F ; <br /> Moving <br /> i <br /> Moving .......... Area .......94D........................ p .................................... � <br /> o <br /> MODIIe Home Slope .......................................... <br /> .... . <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... A <br /> Well .......... ho <br /> garage, mote, etc.I Dry Well .......... a <br /> •••••��� �/ Seepage Trench .......... W <br /> Subdivision .......... ..f„ft„(,. <br /> Camping UnitPriv ... ...... V1 <br /> Seepage Bed ...I...... E <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road J) C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r = <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. b 0' <br /> ---------------------------------------------------------------------- <br /> Z <br /> 5. Lot Size: Fig. A. 6. Loc tion: <br /> ft. x .............. ft. — ............... sq.ft. <br /> c ... ... ....................................................... u <br /> mo <br /> i / <br /> o N <br /> 0 <br /> N O <br /> O 7 <br /> j' <br /> 0 : ,1 <br /> O <br /> J <br /> :-v T <br /> O <br /> d <br /> 7 <br /> b <br /> m <br /> Or <br /> S � �y 6 <br /> C-lz7iv n-� m FA a a < <br /> T r Suefr..�lP So. � [X'<r/w z oo m n '- 7m0 <br /> Urt ' o O 3 <br /> : m <br /> m <br /> p <br /> Signature of Owner or Agent Date 'Z C <br /> x <br /> Remarks ......................................................................................................................................................................... m m <br /> v <br /> SII <br /> ...................... m <br /> m <br /> Inspection Date ....................................... ?,, <br /> ............... : .`S: .u' . o SX m <br /> Zoning nistrator 8 8 8 8 8 n <br /> NOTE: A preliminary site inspection must be made pproval 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 plumbing 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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />