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Burnett County Office of toning Administrator �' o <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 q <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 and 3 a <br /> regulations of the State of Wisconsin. <br /> S�euen <br /> H..,..iF?^.. ! .f...m:.... '. ! 1.......... ............................................................................................ <br /> OWNER (please Orintl ' CONTRACTOR or SURVEYOR or AGENT , <br /> :. .. .L�4X..7.1.44................................................ ............................................................................................ <br /> ADDRESS ADDRESS ' <br /> Da� � .. ... .J.!. .......5!f.a. .............. ........................................................................................ <br /> ADDRESS if ADDRESSlq <br /> �a. ...........................................................................................- $....................................................... EGo <br /> PHONE................................................................................. WPHONE <br /> .......... <br /> . .E. .............. ........................................................... <br /> PLUMBER LL DRILLER.. 4 <br /> •.� <br /> ........................................................................................... .AD......D. ..RES.. ................................................................................ _. (� <br /> ADDRESS S <br /> n C <br /> ........................................................................................... . .......................................... ....................................... <br /> PHONE PHON........E 0 N r <br /> DESCRIPTION 4. SanitaryFacilities: o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details """"" i o i <br /> New Building „)/,,,,, Type of Construction: No. Bedrooms .......... R <br /> Addition r.,�a.r 9 Septic Tank Size Gals. .......... <br /> .......... .,7....�..'C4... . ..... fr?. ..3�.... ft. .......... �. <br /> Sanitary .......... Size .P.49..... ft. x ... <br /> Filling/Grading ,,........ Height�.�.'� ":. Stories ...../ 4a. Absorption Field Site: ' ;Q <br /> Moving .......... Area ;Type .................................... '• : o ,� <br /> ........................................... <br /> Mobile Home Slope .......................................... <br /> .......... y » <br /> Privy .......... 3. Use (describe exactly, 1 •family Perc. Rate ................................... o <br /> Well .......... home,garage,motel, etc.) Dry Well .......... m `• i <br /> Seepage Trench o <br /> Subdivision .......... ...2..Z+45 .l.4.%17.4.V ........... .......... <br /> -- —Camping Unit .......... Privy .......... <br /> .................................................... i <br /> Seepage Bed .......... <br /> ------------------------------------------------------------ 1N TM <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. c 'I,1 <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <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. ;N <br /> ---------------------------------------------------------------- 'I <br /> 5. Lot Size: Fig. A. 6. Location: d' <br /> ..................................... <br /> 3aO.... ft. x ...G.�Qn. ft. - ...�..GA�re.S.... sq.ft. /n'C ? ... ....4w :t <br /> N O <br /> o <br /> o N <br /> 0 <br /> p <br /> 70 <br /> i I <br /> 0 <br /> W a <br /> D n v N r D W <br /> m "a•<c —' nm anA <br /> � N _ <br /> Z fq o m •;! D 1 <br /> v ' of <br /> Co : M <br /> A <br /> M <br /> � � C <br /> m <br /> A <br /> Date <br /> Signature of Owner or Agent o <br /> o : <br /> N <br /> Remarks m n <br /> w <br /> ................................................... ...................................................... ....�..f/..}. ...........�J...... <br /> ......... ... <br /> m <br /> Inspection Date ....................................... .�. .. <br /> ?�� <br /> oning Admin 98 99 co co fA <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 />