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Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 �• <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Pernit for the work described and located as < — °U <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> m <br /> OWNER{(please <br /> Code,and all other applicable Count Ordinances <br /> ACTOR or SURVEYOR or of the State of Wisconsin. 3 a <br /> JJ Yregulations <br /> a <br /> O <br /> /'{'! / S.l........... .......................� 1................................. ................................................. ............ = i� m <br /> .. ....pp..-..I.. !% <br /> .......t�:.LA. .............................................. .... . ...................................AGENT................................ �' .� <br /> ADDRESS ADDRESS + <br /> ADDRESS ADDRESS <br /> ........................................................................................... <br /> ............................................................................................ <br /> PHONEI .......................... PHONE <br /> 1�!. .�..5...........K.Q.`P�� ........................ <br /> PLUMBER WELL DRILLER u <br /> 6s� <br /> ...... ......t. ......... ...r.., cti..s......................... .. .. .. ............................... ..... . ................................. <br /> ADDRESS ADDRESS :111 n o <br /> ..6.-.:.P........................................................ <br /> ............................................................................................ <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: + 0 o 0 <br /> No. Bathrooms <br /> 1. Work: 2. New Building Details n o <br /> New Building .......... Type of Construction: No. Bedrooms .-Lo o :U <br /> Septic Tank Size Gals. �o�-®Q 34 ' <br /> Addition ....... .................................................... <br /> Sanitary .. ... Size .............. ft. x .............. ft. .......... y <br /> Filling .......... Height........... Stories ............... 4a. Absorption Field Site: <br /> ... Soil Type ........... : r <br /> Moving .......... Area ........................................ o <br /> Slope .......... `�..................... . <br /> Grading .......... .0�......Q.....i............ <br /> Mobile Home .......... 3. Use (describe exact 1 -famil <br /> Fare. Rate ....az.-. .�.c.^........ k i <br /> Privy .......... home,garage, motel, etc. Dry Well .......... W <br /> Well .......... .................................................... Privy .......... <br /> Subdivision N t+^ <br /> """"" ,o <br /> Seepage Bed <br /> -------------- — — — -------------- --- — <br /> — — -- — — --------- <br /> 4 an <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road N :� <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 EXISTINGZ. p < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Z. o pt <br /> ---------- ------------------------------------- ---------- -- V� <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. .......................................... ............................ <br /> E <br /> 01 <br /> N <br /> f i O <br /> E b <br /> o PQ <br /> -a <br /> 0 <br /> � s <br /> v73 <br /> C: zo <br /> d <br /> i1 <br /> atrv :EOF <br /> Z <br /> n yj c <" " <br /> In <br /> z o0m <br /> 0 0 : �. <br /> e, <br /> 6 <br /> o <br /> �-. �:. <br /> �� -.. .. ........ .. .....s `f.. . <br /> Signature of Owner or Agent Date GI X <br /> m T <br /> Remarks ......................................................................................................................................................................... : k 0 <br /> . <br /> _ <br /> ........................................................................................................................................................................................ . . . <br /> ............................................................................................................................................. .............. <br /> � <br /> Inspection Date ........... <br /> Z . . rn <br /> Carting <br /> rnm <br /> Ad Inistrator h"✓ . ' . 0 0 0 000 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilltios <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must he 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 issuer). A permit may be revoked if misrepresentation of any f the information conveyer) here <br /> With is found to exist. Changes In plans or specifications shall not be made without approval of the Zoning Adrn inistratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />