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Burnett County Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3 y <br /> m o <br /> TO THE ZQOING,ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as '� vN, �` :V, <br /> shown hergm. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m = <br /> m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a i� iVJ <br /> o <br /> .�atuEkf�J�......1f�4r�1.��..r�c�1Z .......... -....-. . <br /> �................... <br /> ^_ <br /> f <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .................. !8, .....G.2...8 ....................................... Zf5i��........................... a <br /> . . m <br /> AjD�D�RI ESS �'7 ADDRESS m <br /> .. ...................g3..u............... . <br /> ADDRESS............................................................................ <br /> ADDRESS <br /> !........... . . . ...................................................................................... <br /> PHONE PHONE :b <br /> ........................................................................................... . .......................................................................................... <br /> PLUMBER WELL DRILLER <br /> A...D..D...R..E..S..S................................. . . . .. . . .. . <br /> . ............................................................... <br /> ADDRESS <br /> ................... <br /> ..... ..... . ... ...... . ..... ........ SG <br /> 'o <br /> . ... ...... <br /> ........................................................................................... . ................................................. ........................ .... . <br /> PHONE PHONE Z 0 <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° o ° <br /> ( T <br /> 1. Work: 2. New Building Details No. Bathrooms ....��.... c" o <br /> New Building .... .. Type of Construction: No. Bedrooms ... ..... <br /> Addition 'C-10 l).., lQ/.Q�'!� .. Septic Tank Size Gals. '�.,w 4? !�j < <br /> .......... ........... lIy\ I <br /> Sanitary ?ti Size Z(v....... ft. x ...3..(c.. ft. <br /> Filiing)Grading .......... Height........q... Stories ...1......... 4a. Absorption Field Site: <br /> Moving .......... Area F• 3.4:). Soil Type ..........k...+¢.N!�........... ^ ' .r <br /> ............ .... ........... ?? :n <br /> Mobile Home Slope .................t. !)...... :� <br /> .......... <br /> Privy ... 3. Use (describe exactly, 1 -Tamil Perc. Rate ................... ........... <br /> "'" Dry Well """"" <br /> Well ....?C,.. home garage, motel, etc.) I <br /> Seepage Trench !� E <br /> Subdivision .......... .................................................... Priv ......... .\ <br /> CampingUnit .......... .................................................... y <br /> Seepage Bed rA <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be, sketched in Fig. A. 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- �- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING t <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o= <br /> -------------------------------------- _ ----------- \ <br /> 5. Lot Size: / Fig. A. 6. Location: <br /> ..,03.. .0..... ft. x ../Ck.�B.�.. ft. — .02.(.7�t..(YQ..v........ sq. ft. ............................................................................... Q a� <br /> Wo o <br /> uE <br /> 0 <br /> N <br /> N <br /> Y O <br /> _ <br /> s <br /> � T <br /> U Z <br /> ,�J o <br /> '1 m <br /> i ro <br /> u <br /> �7 (n r m n+ m Z <br /> m N n C` <br /> O < G m <br /> m <br /> Z o8o 77 <br /> o = n n 3 <br /> Ee:qX Fa <br /> = _ <br /> 1U 0 <br /> ra�uref caner or Agent Date <br /> X v <br /> Remarks ... . .. C ... /--E �- <br /> �� . ...... ....... ............................................................................................................................ . <br /> �, 11 <br /> ......................................................./........................................... ... ............. . .... .. .. .. .... ..i........................... m <br /> Inspection Date ...�G....... ..- ,.).. .. .... 'r............... `a Sao o o m <br /> 8 <br /> ....... <br /> M <br /> Zoning Admin trator J . . 8 00 8 00 <br /> 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 most 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 />