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Burnett County Office of Zoning Administrator Cn IU o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3' o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as m <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. 3 a <br /> Ft <br /> 0 <br /> OWNER (please print) CONTRACTOR or <br /> SURVEYOR or AGENT � 19 <br /> a <br /> r�..T r.....).......r .a.1c.....7...5..Y................................ ............................................................................................ d <br /> ADDRESS ADDRESS » <br /> —c r <br /> ADDRESS ADDRESS <br /> b'.6.6.. ..y... ................................................ ............................................................................................ <br /> PHONE PHONE <br /> ........................................................................................... . .....................................—.................................................. <br /> PLUMBER WELL DRILLER <br /> .......... <br /> ..... . .................................................................................. .ADD'"' 'D...R... ..................................... ... <br /> .. ........................ <br /> O <br /> ADDRESS ESS.... » <br /> 0 i <br /> ........................................................................................... ............................................................................................ <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: 0 8 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •"""'•' o <br /> No. Bedrooms <br /> New building Type of Construction: """"" M <br /> Addition .......... ...... ......... Septic Tank Size Gals. .......... i <br /> Sanitary .......... Size ...... ... ft. x ....Z..cf.... ft. .......... C <br /> Filling/Grading .......... �.... Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area Soil Type .................................... '" o i <br /> ..................................I........ <br /> Mobile Home Slope .......................................... p <br /> .......... » ' <br /> Privy .......... 3. Use (describe exactly, 1 -family Fare. Rate ................................... C <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> SubdivisionSeepage Trench .......... r i <br /> .......... r.. A�rlf.� .< <br /> . -. . ...........I......... <br /> Privy <br /> Camping Unit W <br /> Seepage Bed <br /> ______ __----____—_ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched In Fig. A. Include road Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o- <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. Lot Size: 10,104, Fig. A. 6. Location: <br /> ................ ft. x . ............ ft. — ..Y.l�..9�.9.6 r?..... sq. ft. ............................................................................... i <br /> P <br /> N <br /> n <br /> N O <br /> o gyp" <br /> 7 1W <br /> O <br /> v � <br /> :xV m <br /> � o <br /> v <br /> m <br /> SCC / / /(` 17 C <br /> m (An n < 4 <br /> £ <br /> N d m <br /> a of e, y ,� m <br /> m . <br /> Z 0 0 n n <br /> O _ n <br /> O rr <br /> . ..... ........................................................ \O <br /> Si lure of Owner or Agent Date — <br /> X <br /> Remarks ......................................................................................................................................................................... m rr <br /> p C <br /> rr <br /> a o � ZnN � m _ vn <br /> Inspection Date ....................................... ..... o u R <br /> ............................9............... 0 0 0 <br /> Zonin Adminis rotor /�J $ o $ o o $ V <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 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 b"e made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />