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e17,, <br /> Burnett bounty Office of Zoning Administrator <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 + <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and6 i <br /> regulations of the State of Wisconsin. 3• <br /> iDwNE (plsese print _ CONTRACTOR or SURVEYOR or AGENT r <br /> `1...`.. ......... SGr . .......................................................................................... <br /> ADDRESS ADDRESS <br /> r YNc.......... 5..` � <br /> ..... . .. ............................................................................................ <br /> ADDRESS ADDRESS , <br /> PHONE PHONE................................................................................ .� <br /> ...............N..l. .. .... ��'..:...`Zo . .................... <br /> i <br /> .................................................... ...................................... ............................................................................................ <br /> PLUMBER,r� _ WELL DRILLER <br /> \-�N j�2b�f i o <br /> ADDRESS ADDRESS n C <br /> ^. c <br /> ........................................................................................... . .. . ................................................................................... - O <br /> PHONE P..HON..E M "- <br /> DESCRIPTION 4. Sanitary Facilities: P o <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> • o i <br /> Naw Building .......... Type of Constructigp: No. Bedrooms .......... <br /> Addition .,.. (,�6YsPJ 2..:............ Septic Tank Size Gals. .......... <br /> Sanitary Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... ` r i <br /> ........................................... <br /> o <br /> MODIIe Home Slope .......................................... .. <br /> Privy .......... 3. Use (describe exactly 1 -family <br /> Perc. Rate ................................... d <br /> Wali home,garage,motel, etc.) Dry Well .......... T <br /> suDdwielonSeepage Trench Z <br /> .......... .................................................... <br /> .......... o <br /> Camping Unit .......... Privy .......... <br /> ............................................... .... Seepage Bed i <br /> ---------------------------------------------------------------- •� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. :� C \� <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is located at FL <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :Q - <br /> ______________________________________________________________________ <br /> 5. Lo Size: Fig. A. 6. Location: <br /> I � <br /> 53 c� /.� 1 f U !onto-C,wuc ...................... p <br /> .. '20.. ft. x .............. ft. — ..... .......�....... sq. ft. ................................ --� <br /> N O <br /> o <br /> v <br /> 0 <br /> 0 <br /> F <br /> -D12Wna( 76 <br /> cue <br /> �erM f $ la 861P marm <br /> C..) 4r jai A.c! <br /> 0 <br /> Ad U o <br /> o- /1'LauL�� � a <br /> /f <br /> v m r D W <br /> r1pi c < > > n EL E. fll <br /> J mNZ : am 55A <br /> V•� N O <br /> C O C <br /> yi / <br /> 2 — .Sign lure of Owner or AgeDateRemarks ........... G: Q a <br /> .................................fl........................... m <br /> m •• <br /> u <br /> ........................................................................................................................................................................................ <br /> N : o <br /> g <br /> .. <br /> Inspection Date �� U (P N N O u rrn <br /> ...................................... <br /> ....................................... ................. <br /> Zoning Ad istrator g $ g 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 been 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 />