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Burnett County Office of Zoning Administrator d0 0 <br /> J <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 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 mc V iw <br /> Ordinance,.Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a W <br /> s'Cl�� So ^/ N o <br /> ......... ....... ..... ... ................................................. c <br /> .... ..... ..... _ J <br /> OWNER (please print) CONTRACTOR or SU RVEVOR or AGENT a 0 <br /> J `7f Ye yr 04; .ST K S el <br /> ..... ... ........................................................... ............................................................................................ [ <br /> ADDRESS ADDRESS m f[ <br /> /til/ VN.2H h/zS M �� .. <br /> ADDRESS ADDRESS C;\ <br /> ........... <br /> PHO�NIE................. .............................................................. .PHON.E............. <br /> ................. <br /> ........ <br /> ...... <br /> ........ <br /> ...... <br /> .......... <br /> . \a <br /> ....V.0 M.BE.�.. ....W.......r..t-/Z..[i�3a n ................................ .......... . . 4, i U E �7 <br /> PL . ... . . . .. . ....................................................................... <br /> ' // e <br /> �— r— p y$' ( WELL DRILLER :\ <br /> ADDRESS ADDRESS » o <br /> ......l?... ...5�.."-....tea.. / .7................................................ <br /> ............................................................................................ o <br /> PHONE PHONE Z N <br /> r- <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms .....�... � <br /> 2. New Building Details d <br /> New Building Type of Construction: No. Bedrooms ....a-.. i°q o <br /> Septic Tank Size Gals. .�5 <br /> Addition .......... .................................................... Sep :W < <br /> Sanitary "�- Size ft. x ft. """"" <br /> Moving <br /> .......... Height............. Stories ............... <br /> 4a. Absorption Field Site: <br /> Moving Soil Type .................................... � a <br /> .......... Area ........................... ............. <br /> Mobile Home .......... Slope .......................................... •. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........... ................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... i <br /> Subdivision .vd Seepage Trench <br /> l.- .......... ' <br /> !d <br /> Camping Unit .......... Privy .......... ; <br /> .................................................... <br /> Seepage Bed ....... <br /> --------------------- ----------------------------------------------- ad <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc-, should be sketched in Fig. A. Include road C <br /> CT a <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highway inter- I (� d <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. �i o� <br /> J :IA <br /> 5. Lot Size: Fig. A. 6. Location: t <br /> ................ ft. x .............. ft. — ............................... sq. it. Cel i <br /> UI <br /> R <br /> vo 0 <br /> J <br /> 0 <br /> O <br /> J <br /> S <br /> Z <br /> O <br /> as <br /> u <br /> J <br /> N <br /> 77 Ar v Z <br /> =_ m <br /> Z o o' a n 70 <br /> o J nm 3 <br /> in - <br /> `n <br /> moo <br /> Sign re of O ner or Agent Date <br /> Remarks ...... . rn <br /> -n ' . . . . . . 0 <br /> m <br /> Ge <br /> ........... y........................................................ ............................................................................................................ — <br /> ............� vv�� l...:D..//e;j'i'.C. .C.L .................................. .. �d�injs�ra�or <br /> ...................... <br /> Inspection Date �...l...✓.p ........... ..... ... .... E " N o o m...................... a o 0 8 8 8 S o o fn <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 riot 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />