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Burnett County Office of Zoning Administrator 0 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <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 �a <br /> and the laws and regulations of the State of Wisconsin. <br /> ......... ... ........... ........ . . .. . ..... ..... .. ........................... <br /> . .. <br /> ......... <br /> OWNE.R/(please print) CONTRACTOR or SUR EYOR or AGENT a ; <br /> m m <br /> �` NN a r <br /> ............................hoo5lw �1....................... ................. P. .......................... .................................. v� <br /> ADDRESa ADDRESS <br /> R .:.` . ... Ulf.... .U................................ ... ........................................................................................ 4� Z <br /> ADDRESS I ` ADDRESS ' <br /> �.................. . . . ...................................................................................... cV\ <br /> PHONE PHONE <br /> ............. . .3.:-....5.. .3.C�............................... . . . . . . .. . . ....................................................................... <br /> PLUMBER WELL DRILLER :W <br /> O <br /> ADDRESSADDRESS n o <br /> ........................................................................................... . . ..' . ............................................................................... : . <br /> Z <br /> o <br /> PHONE PHON.... EE0 <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> v <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> No. Bedrooms z <br /> New Building .......... Type of Construction: """'"' m <br /> Addition . .,,,,,... Septic Tank Size Gals. .......... 9 <br /> .......... ............................... ........... <br /> Sanitary Size .../&..... ft. x ft. """"" ' <br /> Absorption Field Site:Absorp <br /> FillinglGratling .......... Height Stories ............... 4a. <br /> Soil Type .................................... rJ-� r E <br /> Moving .......... Area ...... ......... .............. — o <br /> Mobile Home .......... <br /> slope ........................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Perc. Rate ................................... iU <br /> Dry Well <br /> Well home arage, motel, etc.) "' 00 <br /> Subdivision Seepage Trench .......... <br /> .......... ........ "........... . ...— Privy JJJSSS <br /> ........................ <br /> Camping Unit <br /> Seepage Bed <br /> — .......... : <br /> \ be <br /> Location of proposed structures and existing structures,well, sewage systems, roads, eta,should be sketched in rig. 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 - <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -------------------__--___------_---____--_----_----------. ___— <br /> 5. Lot Size: Fig. A. 6. Location: 5s <br /> . ........., fD !Z_ <br /> .... <br /> ............ ft. x .............. ft. —� UL��. ........ sq. ft. ......L-of................................................. . f <br /> I <br /> lav tc)L. so <br /> N <br /> it <br /> o <br /> 0 <br /> I o <br /> v <br /> m <br /> �tSTM Y C <br /> �l it <br /> I <br /> l 9Nr � wmz <br /> � as <br /> '-lo an <br /> . vam <br /> L4 1b0 Z O o Dn n <br /> O n o <br /> .a-1e............ <br /> y-.a. .-.g.7 <br /> SI Wture of Owner or Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... <br /> T <br /> \i <br /> .......................................................................................................................y...............�j./........1.y/.�.�.1............... ; <br /> Inspection Date ....................................... ..?,., , <br /> i.�.tic+,:,.....1 —T` 4k . . ........... e u a o N <br /> Zoning Administr t r ✓II 1 <br /> NOTE: A preliminary site inspection must be made and pproval granted on all structures Involving sanitrlY facil0l"I <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 stalt any bulld <br /> - <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 Admimstrett�S <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. �{\' <br />