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b, JI <br /> Burnett County Office of Zoning Administre for <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT9 ° y1 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <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 nd the laws and 3 , <br /> r1NER <br /> lations of the Stake of Wisconsin. $ i <br /> ................... ... ... .� A � �)please print) CONTRA TOR rSURVEVOR v, EN <br /> AppRE....8.01.I..._.....I�-33r��..�...(�.t.�—................I}..Q............................ ......Qz IfXI..C..�.�p..........................��................/......�................ ...... d s— �J <br /> 55.77.1.MY.1el.l.y..�...11.4-t.�.... ...1.:? .................. AD. I�.l `:.Cf............. .......��..U............. ....... . <br /> ADDRESS ADDRESS i :::7� <br /> ...... . <br /> ........................................................................................... ..................................................................... Pr— <br /> ......... :tel <br /> PHONE PHONE <br /> .. . ...... ............................................................................... . . . ............................................................................. ....... <br /> PLUMBER WELL DRILLER <br /> . . . ................................................................................ . . .. ...................................................................... ....... <br /> i <br /> ADDRESS ADD.. ....R..ES..S n G <br /> ........................................................................................... .................................................................................... ....... <br /> PNONE PHONE Z r '� <br /> DESCRIPTION 4. Sanitary Facilities: o ° <br /> No. Bathrooms <br /> i. Work: 2. New BuildingDetails " """' i 'o <br /> New Building .......... Type of Construction: No. Bedrooms .. ....... � <br /> Septic Tank Size Gals. .. ....... <br /> Addition .......... .................................................... < <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> . ....... <br /> Filling/Grading ...•...... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ............................ ....... <br /> Mobile Home .................................. <br /> i o <br /> Slope .................................. ....... <br /> ••........ » <br /> Privy .......... 3. Use (describe exactly,'1 •family Perc. Rate ........................... ....... <br /> n <br /> Well .. home,garage,motel, etc.) Dry Well .. ....... a <br /> Seepage Trench o <br /> Subdivision .. .. .................................................... ..... <br /> Privy .. ....... <br /> Camping Unit L1 <br /> .......... .................................................... Seepage Bed �Z <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fi . A. m <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. 5 <br /> a i <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ...................................................................... ........ <br /> C ^ ' <br /> IU N O <br /> Cyt `1 I O 7 <br /> 04 <br /> ( _ 9 <br /> T <br /> Z <br /> O <br /> N <br /> tG <br /> m <br /> C <br /> 9 N M Mt- D m m -0 <br /> v6 a a m a' < d C y f0 <br /> 5 <br /> Ci <br /> 5 <br /> N ° f0 <br /> Z o � D 1 <br /> P N a <br /> LI: a <br /> 0o <br /> m � C <br /> x t. : rn <br /> ........................................................................... ...................................... <br /> Signature of Owner or Agent Date $ <br /> T y ' <br /> Remarks v <br /> m �• <br /> 0 <br /> ......................................................................................................... ... ..................... ... ... ..................... : $ : o <br /> Inspection Date r v v f N T <br /> . ..... ...... <br /> ..................4.................... g <noo �nm <br /> Zonin Administra r 'n 8 88 8 8 8 m <br /> NOTE: A preliminary site inspection must be made and site appro al granted on all structures involving sanitary f cilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has be n issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AF PROVED. <br />