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t County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> o <br /> O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < ,n :J�'. <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m i <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ........................................................... <br /> OWNER ( a e print) CO RACTOR or S RV VOR or AGENT n <br /> ... .. . .. .. . . ,. ............ , <br /> ADDRESS ADDRESS i <br /> LGii�.�. �i�y.3......... ...................................... <br /> ..... .... <br /> ADDRESS ADDRESS � ' <br /> ........................................................................................... ...... <br /> .... ..... .......... .. ...... ...... . .... ...... .... . ....... ........... <br /> PHONE PHONE •� <br /> ............................................................................................ <br /> PLUMBER WELL DRILLER �C <br /> ........................JJ}}JJtttt��....... ................... ' ................ . . .................................................................................. <br /> ......... ..... ... ..... \ <br /> ADDRESS ;ro <br /> .I` `.^...................................................... ............................................................................................ 3 r: <br /> PHONE •2(f Q �5P 91 PHONE Z w, r <br /> DESCRIP ION V� 4. Sanitary Facilities: o °» <br /> No. Bathrooms v ' <br /> 1. Work: 2. New Building Details "�'•/""' <br /> New Building .......... Type of Construction: No. Bedrooms .orS..... r� ;lS .� <br /> MD.�k,'1 <br /> Tank Size Gals.. ... <br /> Addition .......... .................................................... Sep .\ < <br /> Sanitary ....../r' Size .............. ft. x .............. ft. .......... '� : ' <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: '• <br /> Type Soil Typ .................................... r <br /> Moving .......... Area ........................................... So <br /> Mobile Home Slope .......................................... : p <br /> Pere. Rate ................................... <br /> Privy .......... 3. Use (describe exactly, 1 family ` <br /> Dry Well <br /> Well ....� home,garage, motel, etc.) .� <br /> Subdivision ......... Seepage Trench .......... <br /> .................................................... Privy .......... � <br /> Camping Unit .......... .................................................... Seepage Bed Ca; <br /> Location of proposed structures and existing structures well, sewage systems, roads, etc., should be sketched in Fig. A. Include road .0 <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 ' <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------------------------------- <br /> 5. <br /> ---------------------__-----_----------_—_---- --_---__-5. Lot Size: �^ tea^ Fig. A. 6. Location: (1a <br /> ................ ft. x .............. ft. — ............................... sq.ft. ......................../ .... .................................... <br /> M NC v <br /> m <br /> 0. <br /> N O <br /> 5 044+ <br /> � <br /> W <br /> �o SXJO <br /> �L> o <br /> / �vopfi� �Q �ro�wsr� 32 lG a [ <br /> �� �' G' T <br /> Z <br /> n 39d- <br /> 7J si- <br /> On <br /> y M y 0 m <br /> to <br /> N_. c: m <br /> a v, N. � m m <br /> Z 00 n a 31 <br /> O O oro � <br /> O <br /> ......................... .lQ..Z �S`......... w 0 . . c <br /> S4aatuipa or Agent Date " <br /> X � <br /> m m <br /> Remarks ......................................................................................................................................................................... m <br /> : <br /> ................................................................................................................. .................... . ...r...,'.y—........................... <br /> ... <br /> Inspection Date ....................................... .... %' P .-.. U P o N <br /> T <br /> M <br /> m <br /> Zoning AdminisR ator : : 8 8 (`�8 8 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary f c liths <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be atta hed 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />