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Burnett County Office of Zoning Administrator --r! <br /> o <br /> Z. <br /> A0PLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> ° o <br /> TO THE FONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e l <br /> Ordina i Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a i W <br /> IJD.. T. . � <br /> .. <br /> ✓... ... . ..... ............................ <br /> ase <br /> d <br /> OWNER (pleprint) CONTRACTOR or SURVEYOR or AGENT n <br /> ........L6d.�S...B.e Oc..I ;c. .......................................................................................... . <br /> ADDRESS ADDRESS <br /> �o .......... ............................................................................................ <br /> ADDRESS ADDRESS <br /> ........................... .. ......... . .......................................................................................... r'c' <br /> PHONE PHONE f <br /> .. . . . ............. ..OtRP.fL................ <br /> ..... <br /> v. <br /> PLUMBER —�-�b WELL DRILLER <br /> ........................!..I: ..................... . .......................... <br /> ADDRESS . 0 <br /> ................................................. \ �� <br /> ADDRESS <br /> . ..7.......................... <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building Ty e of Constructio No. Bedrooms .... ;'\Q M <br /> q �.... <br /> AdditionP�„bXhc,,,��r,Ziµ,/„fy'(,'!aNi1�” Septic Tank Size Gals. .......... <br /> ...�./.. .. ........lT <br /> Sanitary ...1.5.... Site ...ems..W... ft. x ...aV..G.. . ft. <br /> / 1. X 4a. Absorption Field Site: <br /> Filling/Gratling .......... Height.../y..... Stories .. . .......... <br /> Moving .......... Area .......*5.a Q...,.5 7 Soil Type .................................... �: o <br /> .e. ............ <br /> Mobile Home Slope .......................................... F <br /> 41 <br /> Rate ............... ............... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. <br /> Well R <br /> Well .,x.... home,garage, motel, etc.) Dry """"" 1x <br /> Subdivision �� / Seepage Trench .......... >J <br /> .......... . 11......................... Privy r <br /> Camping Unit <br /> .................................... . . i <br /> .......... . ... .......... <br /> Seepage Bed <br /> Location of proposed structures and existing structures well,sewage systems, roads etc., should be sketched in Fig A. Include road Q Q :M <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 w m <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. : o a <br /> _--_--_—__— Vi <br /> 5. Lot-Size: �- .z Fig. A. 6. Lo$�tion: /� o <br /> ..�i ..... ft. x ..h� ft. — ...2.:....1....�. .......... sq.ft. ...(.3. .Tk�A..,. BQI.�O..� � 1%C,f E E� <br /> / e <br /> m <br /> n <br /> o <br /> o <br /> lio 01 <br /> 76 � <br /> r S'nrrr U�ELtr 'rV � <br /> IF <br /> to <br /> 1 -7 <br /> O <br /> Q � <br /> m <br /> i <br /> M N r aRZmI S a cwS.Z o o - Z1 <br /> O = ' nm 3 <br /> FL- <br /> t» - <br /> 1 <br /> o y <br /> ja <br /> Ot� o [ C <br /> Signatlfre of <br /> Owner or Agent D <br /> X m <br /> RemrksGl.�. N..'n:! -#..��7,J.7.................................................. ... ................................................................. C <br /> t» <br /> Cl... :.........L:: ...c......:....................c,. '.....:........................................................................................................... N <br /> N- II <br /> .................... .. . .................................. .. ................ ................ ....., .................... <br /> .................... (yam//,- o ` <br /> Inspection Date ..�..`..��. .w....... �jJGh�'�/ .... :.............. ........... Io u o o U m <br /> Zoning Admimst ator K d 8 <br /> �.... .......... <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 He made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />