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Burnett County Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT • <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and M <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the is <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulations of the State of Wisconsin. a O <br /> .... ...R.V..!�..�..f?..... ..,. '�! :�!t.�i w)....................... ...................................................................................... ..... n <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> l3vx494........PR....1........................................... ..................................................................................... ...... <br /> ADDRESS ADDRESS <br /> .A!'t3< r2 {. ,. W............1...g30 <br /> ............................... <br /> .............. .. ..... . . . ........................... ..................................................................................... .... <br /> .. <br /> ADDRESS ADDRESS F` <br /> !T.f � 866 — &� D.,•�.�,-.%......................... . ................................................................................... ...... <br /> PHONE, PHONE �. <br /> .................... ..................................................................................... ...... <br /> PLUMBER WELL DRILLER <br /> .................N..d.4.......1.Coz . ...�� b� w....... ..................................................................................... ...... <br /> ADDRESS • • •• • ADDRESS v\ 0 <br /> n O <br /> 1B 00 <br /> PHONE••• • ••••• PHONEN <br /> 2 0 <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms ; �- <br /> 2. New Building Details "' """' <br /> New Building No. Bedrooms <br /> ....... .. Type of Construction: ... R <br /> Septic Tank Size Gals. <br /> Sanitary .. .. Size ......I.!!.... ft. x .... :eZrr.. ft. <br /> Filling/Grading ...... ... Height....._...... SStpries .....f......... 4a. Absorption F•'ISeld Sita�e: <br /> Moving .......... Area .....?..fZ- Soil Type ....:..:7.!'i <br /> .................. o <br /> MODIIa Home .......... <br /> Slope ..........:«:....e.........:.....:.... m ,.. <br /> Privy /Sc n�� c.� y i i <br /> .......... 3. Use (describe exactly,*1 •family Perc. Rate .............. ............ ....... <br /> Dry Well o <br /> Well m <br /> ,.....,,,, home,garage, motel,etc.) " """' — <br /> Seepage Trench Z <br /> Subdivision rl /Q„ "" o <br /> ,y Priv ... ... <br /> Camping Unit .......... .laer,!r�Y..m....!..T: 4..�a1!.R.N...... <br /> Seepage Bed �� <br /> Location of proposed structures and existing structures well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> C <br /> F : 0 <br /> L <br /> Include <br /> i . A.Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is local d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec on. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :C 0 <br /> ____________________________________________________ _— <br /> 5. Lot Size:r Fig. A. 6. Location: <br /> _.�.G.�?_... ft. ?�...... ft. — .."T�.f79(J_........... scyft. ..... cu?....!.... ..... ........... ...... i f <br /> o 0 <br /> got? t ` ?, <br /> f t,f?w* kf - GA,anSe _1�� <br /> Pw+�ui"c� p <br /> ,/ 1 SAN, fr•v l I t 1) r '~ : o <br /> 43eJrwwPcsn� [T a <br /> .0 :2_ <br /> _ o <br /> 9 <br /> a � � <br /> zj, a Z <br /> o° "a DD0 <br /> c d C�l <br /> - oy� m �o <br /> D ' <br /> (�j o r' o : m <br /> .. r....... A <br /> Signat +of <br /> r A ent DateE Remark .��.....�: ":.G..:...::? ........................................................ <br /> ...........................X. ........................................................................ .. .......... ... ..................................... VI N <br /> Inspection Date .......... /..`...l�.sk....... ..... ..... ✓tr..14 . . . . .....� ® ro m <br /> Zoning Adminis for "rr�, g 8 8 M <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app icalion 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 bee i 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 APPROVED. <br />