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Burnett County Office of Zoning Administrator c - o Z <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 2. 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as '� a <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c �. <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 C- <br /> ...61 <br /> - <br /> .. {1..................... . .......................................................................................... O <br /> OWNER (please <br /> rprint) <br /> /j 11 <br /> c, <br /> CONTRACTOR or SURVEYOR or AGENT 0 , -KAD�J••S!/,,, '•.....wC. .CJ ...../✓••.(...................................... .ADDRESS............................................................................ � �C+ <br /> DRE <br /> ..1.L/. S ../..1.(.�r. .C.�7..F.'./Jcl........`.L/..✓......... . ................................................................ ........................... <br /> ADDRESS _ ADDRESS ° vw <br /> .... ........ �:5......v�. ...................................... . . s <br /> ..... ..................................................................................... <br /> PHONE <br /> PHONE <br /> PLUMBER . .......................................................................................... <br /> WELL DRILLER <br /> . . .................................................................................. <br /> ADD <br /> ADDRESS . .......R..ES........................................ _� <br /> S <br /> n o <br /> ............................................:.............................................. <br /> PHONE .................................... <br /> ..................... <br /> ................................... <br /> Z N <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building ,,,••••... Type of Construction: No. Bedrooms .......... <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Rillingl Grading .....•.... Height............. Stories ............... 4a. Absorption Field Site: '• <br /> Moving ....... .. Area Soil Type .................................... --' <br /> ........................................... <br /> Mobile Home .......... Slope .......................................... o.. <br /> Privy J( Perc. Rate ................................... <br /> ... 3. Use (describe exactly, 1 -family <br /> Well ,.K,•, home,garage, motel, etc.) Dry Well .......... <br /> Subdivision ......... Seepage Trench .......... U� <br /> Camping Unit .... ..... .................................................... Privy .......... <br /> .................................................... <br /> Seepage Bed .......... <br /> ________________________________________________ <br /> Location ofproposed structures and exist <br /> ing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- I _c <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. vl <br /> ------------------------------------__________________________________ <br /> 5. Lot Size: Fig. A. 6. Loc�tiion / <br /> ................ ft. x .............. ft. — 6... -<.-5.. sq. ft. ....Kl...�. ..../!!..A{.,....�.� .../V........ .......... <br /> C i <br /> m <br /> N o <br /> o <br /> O <br /> 0 <br /> s <br /> T <br /> 4l e <br /> H — ?0 O' - <br /> EV <br /> X tar X <br /> a' vNi < tee' m m <br /> Z oo' � yam <br /> ? <br /> 7//// '�o <br /> :Wa <br /> / W <br /> Signature ofmOwner Or A/gent 1 " / Date �J / ,,., ''J <br /> Remarks!../L.Leaz...XK'..... .✓4N...o�,. :-7G�/r .. .11S..G�a7<J...llliZlyln...:7.../'�lvrr.<q..:................. x m <br /> ......................................................................................................................................................................................... e <br /> ........................................................................................................ 1 <br /> �. « m <br /> .. . ..... ...... pp <br /> Inspection Date ....................................... 7r�{ii -C2 rJ $ o U 'o m <br /> Zoning Admi strator $ $ $ $ $ $ rn <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 riot 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 />