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Burnett County Office of Zoning Administre for <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described nd p 0. <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 ii <br /> re�tion;, ate of Wisconsi . <br /> ... ... ..................... ... G....N. ..T...�i' �'.7 J..q.�!............... ...... n <br /> Ot) CONTRALTO r SURVEYOR or AGENT $ <br /> ....... . .... .. --�-� <br /> ADD ESS A�DpRESS <br /> p�.. .l sC37o2.... .................... -SooJ. z..Fti...LU... .... 5. /. .. .. -............ ...... ao <br /> �A DRESS .'^Y ADDRESS <br /> .bh 63s-903A- 1VA-489-o/3,Z......1. .- .. ':` ..::. ..�.................. ...... <br /> ............. <br /> PHONE PHONE <br /> ........................................................................................... ..................................................................................... ...... <br /> PLUMBER WE LL DRILLER r�l <br /> v <br /> ADDRESS ADDRESSn C �.._ <br /> o.. ................ ...... . . . . . ...................................................... . ...........................................—.............................. ...... <br /> PHONE PHONE........ Z <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms c <br /> No. Bedrooms ..... <br /> Naw Building Type f Construction: •• <br /> Addition '` Septic Tank Size Gals. .......... <br /> ?5..... ..... Q ..M...._,....��....... <br /> Sanitary '• ••""' ' <br /> .......... Size ....��.... ft. x ..... ..K.... '. <br /> Filling/Grading .......... r I 4a. Absorption Field Site: <br /> ,,,.,,,,,, Height Stories ..... <br /> Moving .......... Area ........................................... Soil Type ............................ ....... i r. o <br /> Mobile Home Slope .................................. ....... <br /> ...... ... <br /> Privy .......... 3. Use (describe exactly0i family Perc. Rate ........................... ....... <br /> Well .......... home,para e,motel, etc.) Dry Well i <br /> r' gjT NN uu Seepage Trench Z <br /> Subdivision .......... .V.l...�..�:..I..T.�....II /.t.�.11.'.... .. ....... O <br /> Camping Unit Privy .. ....... ` <br /> .......... .................................................... Seepage Bed .. ....... :ice i <br /> ------------------------------------------------------------------- -- t rn <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. c <br /> .Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is local d at O L <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> 1 i <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ------------U-1-3------------------------------------------------------ <br /> 5. Lqt Size: Fig. A. 6. Location: <br /> ..l.Al.0. .............ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> J N O <br /> J � 3 <br /> J a4 � <br /> 0 <br /> m <br /> / ^ 0 <br /> F, o <br /> >,a 4- <br /> iu � m m <br /> '..�� ov < > > nm <br /> C nay <br /> VF' Z,-.y omm <br /> A <br /> } 0 <br /> m <br /> c <br /> ........................... ............................ .................. ...................................... im <br /> im <br /> Signature of Owner or Agent Date <br /> .•r ........ ................................................................ ...............Remarks ............. •..0...... ..... ................... <br /> m <br /> m •• <br /> N <br /> Inspection Date ...................... ... SN+` `�" `N" tmn <br /> ................. .. .............. . .......9.... .................................. . c <br /> Zonin dministrator .88 8 o (0) <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has bee i issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />