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Burnett County Office of Zoning Administrator s - 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 m eQ <br /> T <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances <br /> /and the laws and regulations of the State of W'aconsin. <br /> if� GFR.T..... .... .TE . YtC /J . .................................................... o <br /> a <br /> d <br /> OWNER (please print) <br /> CONTRACTOR or SURVEYOR or AGENT a <br /> ............................................................................................ a <br /> ..�3r... .........a..� ... ..Hd <br /> ADDRESS ADDRESS •* <br /> !� .. .. ........ .. . . .. ".............................................. . .......................................................................................... <br /> `` � CCC <br /> ADDRESS e� ADDRESS <br /> .................................................... <br /> PHONE PHONE <br /> .. . ...... ............................................................................... . . ............................................................ y <br /> .......... <br /> k C <br /> PLUMBER WELL DRILLER � <br /> ADDRESS........ .............. .................................................... .ADDRESS............................................................................ :* N o <br /> Vl1 _, < <br /> PHONE PHONE � <br /> z h r <br /> DESCRIPTION 4. SanitaryFacilities: is o 0 <br /> No. Bathrooms / <br /> 1. Work: 2. New Building Details "" <br /> New Building ,,,,,,,,,, Try+pLe of Construction: No. Bedrooms .......... <br /> Addition J(, y.L„M¢N Septic Tank Size Gals. ...I...... :\ f <br /> Sanitary .......... Size ...�P.�..... ft. x ..... ft. .......... V <br /> FillinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Soil Type .................................... :r - : r <br /> Moving ....... <br /> Mobile Home ....x Slope .................................I........ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision .......... ,�..T/1/N��.Y„f{a.h. .,.,.,,,. Seepage Trench .......... � ; <br /> __Camping Unit— .......... /O.QNG.4/Owe pw�F.�..... Privy .......... <br /> --- Seepage Bed <br /> iNo --L -- ......... <br /> �,,y� p w+ cn :< <br /> Location of proposed structures and existing structures, well, sewagry5 stems�o e,t,TJ _�sh ould be sketched In Fig. Fs. Include road Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter 27 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING I_ <, <br /> STRUCTa <br /> URFS AND PROPOSED STRUCTURES AND ADDITIONS <br /> --—— . a o <br /> [ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> SiPC/T,C—.gft. x .............. ft. — ...... ...._.................. sq. ft. ................................................................ <br /> e <br /> r�� <br /> G o <br /> f w <br /> vl <br /> r1 l <br /> ka <br /> w <br /> Dov p l J f' <br /> z <br /> O o <br /> nor <br /> �� �� _..._ � V1 r � � to 2 <br /> Q © F <br /> �n � � d � m � <br /> oH: m Da T <br /> Z oo n � 77 <br /> o n 3 <br /> En - <br /> 0 <br /> ............... ..................... s c <br /> Signature of Owner or nt Date �tt — <br /> D......:.. .:N...y7.Z. /.................................................................................................................... T1 x m <br /> Remarks .dfJ.... � � � � � ' <br /> m <br /> u <br /> 1T <br /> ........ ........ .... .............................................. <br /> N N W + N T <br /> Inspection Date ....................................... .�/.�.�. ...........`�``•--- In <br /> ZoningAdministrator 8 8 S S 8 8 0 <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, it 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 />