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t <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> ° <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 e, C y � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> �en � n � erc erg f <br /> .. . ....... ......... ................................................ ... ...................................................... _ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT oJA 7. <br /> y!�...w..l..n.s..4.�..ti�........tq ....................... d <br /> .... ...... . . <br /> ADDRESS ADDRESS -� <br /> .......:......:........................ 6 <br /> ADDRESS ADDRESS <br /> ......................6............. ?.....:....... ..3 .......... ............................................................................................ i <br /> PHON .......................................................... PHONE :� <br /> l + <br /> ....Y/J BSE-............... ............................................................................................ :� <br /> PLUMBER WELL DRILLER ':� � °S <br /> ................................................... <br /> ................................................................................ "A' <br /> . <br /> ........... .....DRESS.................................. <br /> ADDRESS AD <br /> < :ti <br /> ........................................................................................... ... ....................................................................................... o <br /> PHONE PHON.. E <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> No. Bathrooms .......... rJ �- -O <br /> 1. Work: 2. New Building Details 'Z E o <br /> New Building .... Type of Cp�tructlon: No. Bedrooms ..,�...-... g� i\ i <br /> Addition f /`.Q,hti,- ,..,,, .. Septic Tank Size Gals. �,........� <br /> ....vv.... Si,z' ......^..... <br /> Sanitary .... . „ Size ....Q1.�... ft. x ..-3-ilk;.... ft. <br /> FillinglGrading ....... .. Height............. Stories ............... 4a. Absorption Field Site: k <br /> Moving .......... Area ) c Soil Type .................................... <br /> :r <br /> Mobile <br /> Home0 0 Slope .......................................... <br /> .......... <br /> Privy Pero. Rate ................................... )` <br /> 3. Use (describe exactly 1 -famil <br /> Well ..,....... home, garage, motel, etc.) Dry Well .......... s <br /> SubdivisionSeepage Trench .......... �� <br /> Camping Unit .......... .................................................... Privy 7x h <br /> Seepage Bed ��...... Tf i <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road � <br /> W Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. It 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 C r ' < a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS 7 o <br /> ----------------------------------------------- <br /> _-- <br /> 5. Lotize: - Fig. A. 6. Location: :T. i () <br /> J...... ... ft. x .......... ft. . ............................... sq.ft. ................. ......... .................................................. <br /> TN 0 <br /> N <br /> ° <br /> r� vl <br /> ° <br /> vl <br /> t <br /> m <br /> t <br /> 0 <br /> rl <br /> W� Sir' <br /> 3 <br /> Nn2riv <br /> C mmc � <br /> �Wr1 <br /> �SG � Z oo <br /> o n <br /> In r✓ v Ca =1 <br /> ..................-�i o 0 p <br /> : ° <br /> Signature el Owne or Agent Date y' N X <br /> Remarks ......,..1. ...A:Ve............................G.�..5....................................�........ <br /> m : <br /> .......................................................................................................... ... ................. :4 . . . . . <br /> G : T <br /> Inspection Date ....................................... . . i Ci d a o o u m <br /> .. .... .. ..... ................................. <br /> ... ........... ..... . . .9. .... .... ................................ I o 0 <br /> Zonin Adm' stretch 8 8 8 8 0 o y <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 percolation test must be attached to <br /> this application before a permit will be issued. Do riot 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 conveyed here- <br /> with Is found to exist. Changes in plans or specifications shall not lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />