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Burnett County Office of Zoning Administrator V - 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o S <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as �7 -a ryy <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use 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 /> .R.A`7L. . ..H . . ..r...a.a.d..a.��...................... ............................................................................................ €r� <br /> OWNE ffAease prin CONTRACTOR or SURVEYOR or AGENT e) : <br /> a <br /> ............. l.....'f3.b'..-..,�1..r...�..n......... ............................................................................................ d <br /> — <br /> ADDR ai SS ADDRESS �- , "b <br /> ADDRESS ADDRESS i kPJ <br /> .............. .................................. ........................................................ .............. ................. . _ s <br /> PHONE PHONE <br /> ........................................................................................... . . . ..................................................................................... <br /> �r <br /> PLUMBER WELL DRfLLER }}----�� <br /> .......... <br /> ........................................................................................... .ADD........R..ES... .................................................................... <br /> ADDRESS S m L) <br /> o <br /> ........................................................................................... ..... ................................................................................... O .+ L <br /> PHONE PHON....E Z r is <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° ET <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New BuildingTkA <br /> No. Bedrooms a <br /> .......... ype f Construc>:1On: •••••.•• ,n <br /> Addition tj �y Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ....V-I. ft. x .....wZ.../. ft. .......... .� <br /> FilfingtGrading ,....,..., HeightcgJX.. Stories ../........... 4a. Absorption Field Site: F <br /> Moving .......... Area Soil Type .................................... r- <br /> .............................. .......... o <br /> Mobile Home .......... Slope ..................................... .... <br /> Privy .........1 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... 'so <br /> Camping Unit .......... Privy .......... i \ <br /> ....................................... <br /> Seepage Bed ......... Vt <br /> ----------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road e <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 < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --------------------------------------------- -- --------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. . ............................... sq.ft. <br /> y(..C1.p.... ft. x .,7.x.0.. <br /> aI ............................................................................. N <br /> -- <br /> °�oonj' <br /> L1 � <br /> G a H as e I ,A �, ? " Ell <br /> 5(1 D o It, <br /> 713 <br /> t � m <br /> r" <br /> 4— a <br /> s 7J N r � rn m Z <br /> Y C m c m <br /> Q \ m <br /> s� m C <br /> am <br /> j Z o- n c 9 <br /> o n� 3 <br /> Z <br /> ..... ........ s 9� p <br /> `............................................... ............................ .. ...... �s o <br /> Signatur of Owner or Agent Date Q;}» <br /> X <br /> m <br /> Remarks .............................................................................................................................................................. m <br /> ........... p <br /> m <br /> �oniAdmi ................. 88888 <br /> Y���...�....�. ................ VII o T <br /> 9 y� V I Nm <br /> Inspection Date ....................................... l �' m <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures in VOlVing 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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />