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Burnett County Office of Zoning Administrator T 0 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 '< — + ;ems <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c jJ <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 0. :N <br /> S.0%64'. ......... G' f. . <br /> o_ <br /> ............................................................. 1 <br /> OWNER (please print) CONTRACTOR or SU RVEVOR or AGENT <br /> R. ......1.........:.............................. C l <br /> ADDRE S ADDRESS <br /> �fJ4ser......W ......SB93 <br /> ADDRESS ADDRESS <br /> :f <br /> ............... <br /> ........................................................................................... ........NE..................................................................... .e <br /> PHONE PHO <br /> . . . ..................................................................................... <br /> PLUMBER WELL DRILLER <br /> ..... . . . ............................................................................... . . ...... . ............................................................................... 'G) <br /> ADDRESS ADDRESS <br /> O <br /> _. <- :� <br /> ............. . . . .................................................................... PHONE p <br /> PHONE ' <br /> Z � <br /> DESCRIPTIONN <br /> r <br /> 4. SanitaryFacilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> .......... <br /> New Building ,./� Typyf Construction: No. Bedrooms .......... 0 ?� <br /> Addition ......... ... , ,,,,, Septic Tank Size Gals. .......... <br /> .......... ...... . . .. <br /> SanitarySize ..�. . ....... ft. x ...rr}}� •...... i <br /> .......... Q.......... ft. <br /> Fillingf Grading .......... Height......�t.`..)� Stories ............... 4a. Absorption Field Site: <br /> o«y'D Soil Type ........... . ......... ..... ...... <br /> Moving .......... Area .................. .. . . . . . YP . . o <br /> Mobile Home .......... Slope .......................................... <br /> Priv Perc. Rate ................................... i <br /> v .......... 3. Use (describe exactly, 1 -family <br /> Dry Well .......... I <br /> Well home,gara e, motel, etc.) c <br /> .......... <br /> Seepage TrenchSubtlivision '-4. .......... <br /> .......... S <br /> Camping Unit .......... Privy .......... <br /> .......................................... yJ-• <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig A. Include road ( c <br /> r <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- �_ 4 • <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING f <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ------------------ ------------------------------- <br /> 5. Lot Size: Fig. A. 6. Loc tion: / <br /> ................ ft. x .............. ft. — ............................... sq.ft. ....(.s4...1.✓... ....:.............,r.. ... 3 <br /> O <br /> IN <br /> 5e(1 0 <br /> °X), <br /> 0 <br /> 0 <br /> on fp rT a < m 2 c m <br /> V on ' mS <br /> 'O (JI Z< C � .0 S <br /> Z oo c <br /> o <br /> � no _ <br /> 0 1 <br /> p e <br /> ..................................... ..:... ... ................ ... ........... . ......... _X!P - <br /> Signature off•Owner or gent Date y p�� ° . ' C <br /> J .C/ 1/ " L 60 X <br /> Remarks.....4......�..�.ZLGtt�u:.f.+..............�Ll..............................................................................................s41.v..... m m <br /> J � . <br /> ......................................................................................................................................................................................................................(..� <br /> ....j'.�..T.. <br /> ....................................................................................................... <br /> Inspection Date ....................................... �............ <br /> ZoningAdmini.str.a.tR.... ... . . <br /> vUa <br /> r <br /> 8U 8N 8O 8N 8O N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />