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,:,I c u-'rt y� <br /> Burnett County Office of Zoning Administrator Up <br /> 3 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT _ <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as 7 <br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin- <br /> l� ✓... <br /> J <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a m <br /> ADDRESS ADDRESS � <br /> y53 ............................................................................................ <br /> ADDRESS ........................................ ADDRESS <br /> PHONE Pl�oivE <br /> ........LA:..i�./�. .N.e..-`'............S-a ... .............................._............................................................ , <br /> PLUMBER WELL DRILLER <br /> S ............................................................................................ <br /> ............../ ..u... ..../........................................... <br /> ADDRESS ADDRESS � 0 <br /> ........................................................................................... ........ <br /> PHONE.................................................................................... o .» <br /> PHONE Z J r <br /> DESCRIPTION 4. Sanitary Facilities: 0 0 <br /> 1. Work: No. Bathrooms .......... v ' <br /> 2. New Building Details <br /> 9 <br /> New Building No. Bedrooms T+ <br /> .,,.,,..., Type of Construction: """ :� � <br /> Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> i� <br /> Filling IGrading ,,........ Height............. Stories ............... 4a. Absorption Field Site: I. [ <br /> h, <br /> Moving .......... Area ........................................... Soil Type .................................... C o <br /> Mobile Home Slope .................................I........ <br /> .......... <br /> .......... <br /> ..... <br /> Rate ................. .. . <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. <br /> well ,..(. home,garage, motel, etc.) Dry Well .......... <br /> SubdivisionSeepage Trench ... <br /> .......... .................................................... <br /> Priv .......... -C <br /> Camping Unit y <br /> .......... .................................................... Seepage Bed � a <br /> ----------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be. sketched In Fig. A. Include road as ;\� <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter °- <br /> section, show U,c intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTIIcG <br /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ------------------------------------------------------------------------ <br /> 5. Lot Size: r Fig. A. 6. Location: fGuN</�' <br /> ................ <br /> ft. x .............. ft. — ..:.�?.... ..�.�°�.."...... sq. ft. ��. .'.P..A.. ..P L.l�..t .a................................, . <br /> /9— <br /> o °q <br /> / µ o <br /> ` T <br /> 0 <br /> 33 <br /> d <br /> J <br /> u <br /> Ili <br /> zv <br /> c d d e m <br /> o Q < 2 F <br /> m �o_ n < — n <br /> a cNn < C cm Z <br /> Q N. m •c `° fT <br /> Z O o n Z <br /> o J n m 3 <br /> S"x on — <br /> rr <br /> ....... rur ... ...or Aq,;../. .. . . . .... ...................................... O ' . : . C <br /> Signature of Owner or Age Date — <br /> x � <br /> Remarks m ' R <br /> i <br /> C : <br /> ....................................................................................................... .. ........................... ......... : 'Q <br /> Inspection Date ../.......... ..... .. U 0 8 0 R <br /> ....................................... ............ 9 <br /> . .................. o o 0 0 <br /> Zonin Admin strator 8 0 0 8 0 0 u <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 he 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 it 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 A(IM MIstretoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />