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Burnett County Office of Zoning Administrator o <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 and located as < 7 <br /> - <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin <br /> ° O <br /> ..................................... ............................................................................................ N _ <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT a m <br /> .... .. ... .............................................. ................................I. .......... a ' <br /> ADDRESS ADDRESSZA <br /> . <br /> .. <br /> . <br /> . <br /> . <br /> . <br /> . <br /> shy.. . ............................................................................... .......... <br /> ADDRESS f / w ADDRESS ?� <br /> ........................................... ............................................... ................................................................................. .......... <br /> PHONE PHONE :J :� � N,�, <br /> C -...8. ! .......20... .. ....................... ................................................................................. .......... <br /> PLUMBER WELL DRILLER <br /> O <br /> ADDRESS ADDRESS <br /> . ...................................................................... ... .......................................................................... .......... O <br /> < :y <br /> O <br /> PHONE PHON.... E <br /> Z <br /> DESCRIPTION 4. Sanitary Facilities: 0 <br /> ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••••• <br /> New Building No. Bedrooms .. .. �� a <br /> g ...X.... Type of Construction: <br /> Addition •„ j�/pajj)„ ,�/J/r,(C,,,,,,,,,,,,• Septic Tank Size Gals. 7„5-�� <br /> Sanitary )( Size ...�2(..... ft. x ...3. ... ft. E <br /> Rulingt Grading ...... ,,, Height.....$...... Stories ...../......... 4a. Absorption Field Site: i <br /> Moving Area ..............�✓.�� ........ Soil Type ................ .:2.. <br /> ....... .. .... ...... . T <br /> Mobile Home .......... Slope .....................)).... ..U...... o <br /> Fare. Rate ............ - :Q) <br /> Privy .......... 3. Use (describe exactly--1-family •••• • E <br /> well <br /> ...A... me arage, motel, etc. Dry Well .......... � <v <br /> Subdivision Seepage Trench .......... n ` <br /> ...............................I.................... U <br /> Camping Unit ....... ... . Priv <br /> .......... ..........ce. 6LL!.... <br /> Seepage Bed / X--�J .r <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched In Fig A. Indo e road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highw'y inter- .� cr <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABELEXISTING f ty <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Yy : 0' <br /> 5. Lot Sime: .. ....�........ ........... 'c t. 6. Location:L.?1�.7...1�{/�L................................ � <br /> 3D g. <br /> raZ6J....... <br /> ft. x .. .�.0.. ft. — C sq.ft. /� f <br /> VV m <br /> K <br /> N O <br /> O 7 <br /> a <br /> O <br /> o <br /> ad <br /> C Y N C N <br /> o = m a m <br /> Z <br /> in - <br /> 9J —1 <br /> 37 <br /> Signature of Owner or Agen Date <br /> X 77 <br /> Remarks ........................................................................................................................ „ ; m <br /> � <br /> ....................................................................................................... .................... .. ..�.^g .... ... o j <br /> SII <br /> Inspection Date ..10..-..�.�-... h ..... ... . . ... ........!— i m <br /> �� Q1Z o m <br /> onin Adminis a or S 8 $�rn <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 percolatior test must be attached to <br /> this application before a permit will be issued. Do riot purchase or install a septic tank, do any pit robing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the in ormation 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 />