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" q 1 <br /> Burnett County Office of Zoning Administrator u 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o � <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� m -j <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all—other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> 0.! ......E7.u..r�Y�// v l r.. �C.. .....pQ(.l..C�.oz .......................... o <br /> OWNER (please print) CONTRACTOR or URVEYOR or AGENT <br /> 414.7.... -r.....%.... ZK.a.................. ............................................................................................ ' <br /> ADDRESS ADDRESS <br /> _. <br /> 7p.rrN...t..l .....u' ....... ...y..��.. <br /> ADD ESS ADDRESS 'J <br /> 6d- 7G 4S 'L <br /> ............................................................................ ............................................................................................ <br /> PH NE •^r PHONE <br /> ... .... ... ....../„ V�S.Q. ................................ . . . . . . ...................................................................... 1 '� <br /> . . ......... . LLE i <br /> PLUMBER �_ WELL DRILLER I <br /> ......................................................................................... `^ � <br /> ADDRESS _ _ ADDRESS \: <br /> Yu� l �✓ ✓ �d =. <br /> ..... P <br /> ......................................... ............................................................................................ � o <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: 0 Q ° <br /> 1 Addition g z• NewBuilding <br /> ofConstruction: <br /> trD : <br /> No. <br /> ptiicTaSize Gals.Bedrooms <br /> New Building T <br /> Sanitary .. ... Size .............. ft. x .............. ft. .......... <br /> F l l i ng I Grading .......... Height............. Stories ............... 4a. Absorption Field Site: ?� <br /> l <br /> Moving .......... Area ........................................... Soil Type .................................... � <br /> Mobile Home Slope ................hy ............. <br /> ti <br /> .......... <br /> ............... _ <br /> Privy .......... 3. Use (describe exactly, 1 family Pere. Rate .................� }- i <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision .......... <br /> Seepage Trench .......... <br /> Camping Unit Privy .......... <br /> .......... .................................................... Seepage Bed ...llrr.-:. <br /> ,hl . <br /> ____________________________________ ___— .N <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road �' 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- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXIST <br /> INC 1 o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ----------------- ---- <br /> ---------- ---------_ _____ ° Cl) <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... E i <br /> N o <br /> o � <br /> O <br /> 0 <br /> 0 <br /> s <br /> a <br /> I T W <br /> z <br /> 0 <br /> d <br /> -C <br /> 0 r v m z <br /> c <br /> c m <br /> n fqQ n� = B. aF <br /> O. C . y^ m <br /> _ m <br /> �o <br /> .............. .....(..1.. G .. <br /> Si nature of caner or Agent Dae — <br /> X <br /> Remarks �.\�/rK4�:.��.�� ............................................................... m i rn <br /> . ............................................................... <br /> ................... .. ........................................................................... M <br /> f» <br /> 'i�9:lSY,7>C! <br /> J8 . UM <br /> Inspection Date ..../ :............ .. ..... ...... ....... .. ............... .................... : a : o m <br /> C ` �i,/Zoning dministratdr 8 8 8 8 N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary foci tics <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 dry 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 Adm inistratot. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />