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Burnett County Office of Zoning Administrator �' c <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described andq 0 ;Q <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 and the laws and <br /> re ulations of the State pf Wipconsin. 3 a <br /> /X ...... t.....1..'e.1.1..�n............................................. . . . . ........................................................................ <br /> OWNER(2pleaseprint) CONTRACTOR or SURVEYOR or AGENT <br /> . +ti..: ?........ �X..yTO ............................................ ............................................................................................ a i <br /> ADDRESS ADDRESS <br /> Tfit...fl.N.u.. ....,.... �.............1�.a9. . .............. <br /> ADDRESS ADDRESS nn ` ((�� 11 <br /> PHONE................................................................................ .PHONE................................................................................ vJ XJ `�/✓ <br /> 0 <br /> �rj�.�5........ ►#` ....................................... ............................................................................................ <br /> PL M E41 WELL DRILLER <br /> �U. S:.:P.!'......................................................... . . . . . ................................................................................. c <br /> ADDRESS ADDRESS <br /> �uYcBB' s o <br /> PHONE PHONE <br /> 9 r <br /> DESCRIPTION 4. Sanitary Facilities: I o c o <br /> 1. Work: 2. New Building Details No. Bathrooms a r <br /> New BuildingType of Construction: No. Bedrooms .. .... 3 <br /> .......... <br /> Addition .................................................... Septic Tank Size Gals. L.QG..4 . <br /> sanitarY ..VV Size .............. ft. x .............. ft. .......... <br /> < n <br /> Filling/Grading ,n,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type ......... . �q orS <br /> .......... ........................................... ;S <br /> MODiIa Home .......... $IOPe ............. .. ..'0.................... .. <br /> Perc. Rate ....... — <br /> Privy 3. Use (describe exact) -fa ,3.- ......... <br /> Well home,garage,motel, etc.) Dry Well .......... JC <br /> SuDtliviaionSeepage Trench .......... 0 <br /> 0 <br /> Camping Unit .......... ....... .. ...:..................................... Privy .......... <br /> .� <br /> . . ..................................... Seepage Bed <br /> ------------------------------------------------------------------=-=- a <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. g <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. `— <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :U1 p <br /> --------------------------- _ __ I <br /> 5. Lot Size: —�+� Fig. A. 6. Location: <br /> ..3.�Q.Q. ft. x .s.d.,1... ft. — ............................... sq. ft. ............................................................................... iq <br /> T <br /> t <br /> j s <br /> See F3m"J31check. Qraco n Z) <br /> o <br /> 7b iE <br /> 1 TR <br /> of o <br /> m <br /> Ll d <br /> 9 to VOA r- D W W <br /> —� am nn � <br /> < d C y p 3 <br /> N n C) <br /> o � o m0 <br /> �a—g7 0 m <br /> , . m..... .......................... ................................... ...................................... � � A <br /> Signatur........e of Owner or Agent Date <br /> o . <br /> Remarks <br /> N <br /> O ' O <br /> n m <br /> Inspection Date ....................................... .... ....... ... . . .' . ..,��, .............. .. o o m <br /> Zoning Administ r � 25/25 g $ g V <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities 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 a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may Ir <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />