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Burnett County Office of Zoning Administrator on - o 0 <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 Fig c <br /> m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a :� <br /> ..... <br /> .............p �!t.. <br /> .. ................................ ....... p ......... n ...................... <br /> OWNER (please print) CON.RACTOR or SURVEYOR AGENT <br /> .101............ Nn C\ <br /> _n <br /> ,.......I:D.e.X Via(......p.�.. ............................................................................................ a <br /> ADDRESSADDRESS <br /> m <br /> . ./.........#.4.b.....a.......... ` .r................................. ............................................................................................ <br /> ADDRESS ADDRESS ;9J <br /> PHONE <br /> ....PHON.......E..................... <br /> ...... <br /> ....... <br /> ....................................... <br /> ........ <br /> . .40.. .......................... <br /> ........ <br /> PLUMBER WELL DRILLER <br /> .................................................................. <br /> ADDRESS ADDRESS o <br /> PHONE <br /> PHONE z <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms .......... Co <br /> 2. New Building Details o <br /> New Building .,,jr Type of Construction: No. Bedrooms .......... <br /> Addition ....... i ....., .,,,,,,,,, Septic Tank Size Gals. .......... i• <br /> Sanitary .......... Size ..oL. ..... ft. <br /> Filling/Grading ,,........ Height..... .... Stories ......L....... 4a. Absorption Field Site: rA E i <br /> G.7a 7a <br /> Moving Area Soil Type .................................... o <br /> Mobile Home .......... $OPe ...............................:.......... it <br /> ^ <br /> Privy ,......... 3. Use (describe exactly, 1 -family Perc. Rate ...................................ll We <br /> Well ,,........ home,garage, motel, etc, Dry u ' <br /> Subdivision ,,,,....,, F Seepage Trench <br /> 4.r..9.p7.�............... .. 1a <br /> Camping Unit .......... �... teP,. . .... Privy .......... <br /> ............S C. . h `J.Q.g.C.. .... Seepage Bed V1 <br /> ______________________________L�X --__________________________________ N <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road <br /> c <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Inter- 0 Q <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection_ CLEARLY LABEL EXISTING {� <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> 5. Lot Size: Fig. A, 6. Location: Il <br /> ..X*...... ft. x ..,3.V... ft. . ............................... sq.ft. ............................................................................... <br /> a <br /> N <br /> (�ri'u f e RLaa <br /> V /U6 <br /> N a O <br /> o � <br /> ry tD <br /> y ! � <br /> E s{it9je" & �yna9e c--7- <br /> 0 <br /> �ccP <br /> 6`ea� z <br /> o <br /> m <br /> (nr v ur mz � <br /> N C <br /> D D <br /> Z o o n <br /> L o <br /> bock �Wo m <br /> ��,z'�'.. <br /> 7............................... c p <br /> Signature of Owner or nt Date — <br /> x � <br /> Remarks m m <br /> „ v <br /> U ll <br /> ...................................... .............. ..................... ..... . . . . . . <br /> c N 'o oSm <br /> . � . � ............................. <br /> Inspection Date xt�. .... 0 0 0 0 0 ' m <br /> p Zoning Admin' trator K U 0 0 0 0 0 fn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faclhtles <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 Al lid <br /> ng until a permit has been issued. A permit may be revoked If misrepresentation Of any of the Information conveyed here <br /> - <br /> rith 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 />