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Burnett County Office of Zoning Administrator ca 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit 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 m1 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a C- <br /> 1 {A�.M.. .......�a.,..../ll�N pnl.......... .......................�R19, .E..._-.. .��. ..... <br /> OWNER (please print) CONTRACTOR or SU RVEVOR or AGENT ma <br /> a�. . . `. ..... hoz...a.lsc.. ............ ............................................................................................ n <br /> A R <br /> ADDRESS ADDRESS <br /> (2�1.. .u.12. ...�....Gc1s ....... .`f.8a. ..................................'r. <br /> ADDRESS ADDRESS <br /> X5....... . 1.-.3Z .................................... ............................................................................................ <br /> PHONET�+ ........................................................................ .PHONE i i <br /> ..................................................................... <br /> M .... <br /> .................... <br /> T <br /> PLUMBER.... WELL DRILLER !til\ <br /> O <br /> ADDRESS ADDRESS n o <br /> o................ o' <br /> < �U <br /> ........................................................................................... ................................................... ....................... ,» <br /> PHONE PHONE Z h r 2 <br /> DESCRIPTION 4. SanitaryFacilities: ° 0 ° V1 <br /> 1, Work: No. Bathrooms .d <br /> 2. New Building Details o <br /> New Buildingv T No. Bedrooms <br /> ,,,,^ Type Const unction: ���������� <br /> Addition .......... OL .............. .. ........... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ....�3..Q..... ft. x ...��..�.. ft. I......... ' <br /> / 4a. Absorption Field Site: <br /> Filling/Grading .......... Height......3.... Stories ...... ........ <br /> Moving .......... Area �D.�p Soil Type .................................... o <br /> Mobile Home Slope .......................................... ^ <br /> .......... <br /> Privy ,,,,...... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well <br /> Well ........ home,garage, motel, etc.) Dry """"" \ <br /> .V4.c ......5.!}..... ...�.�. Seepage Trench .......... <br /> Subdivision ,,,,,,,,,, /CG LS Y(?. (,�.,� <br /> --Camping Unit C7Gf Y{ Privy .......... <br /> .......... ............... . . .G........................... ' <br /> _______________________________________ Seepage Bed____________ +� <br /> w EG� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should he sketched In Fig. A. Include road e 19 <br /> setback, side and back <br /> yard dimension and location and setback from all bodies of water. If properly is located at a highway inter a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O o <br /> ------------------------------ . <br /> 5. Lot Size: ''t`, Fig. A. 6. Location: <br /> ./.P.�...... ft. x ..RA.LV. ft. — ....�.�.. .Q..�n........ sq.ft. ............................................................................... <br /> n <br /> / W o <br /> ILLejej <br /> µ <br /> T <br /> Z <br /> If <br /> �l <br /> I JJ V1 r v to QJ Z <br /> c m m c m <br /> EW las F <br /> � N. 0 � a' mm <br /> o g n <br /> got t31dq <br /> C <br /> is�y <br /> . <br /> 0, Ing <br /> m <br /> )R'emarks <br /> gnature of Owner or Agent Date X <br /> m <br /> m � <br /> e» ' <br /> .......................................................................................................... .... ....... ..................`......................................... <br /> InspectionDate ....................................... .......... .. 7F'. . ... ............................................ u N � <br /> Zon" g Administrator g o '8 g� <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facihtius <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 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 conveyer) here <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistrdtoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />