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Burnet, v ; J Office of Zoning Administrator �' e <br /> APF-JCATION 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 0 �W <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ icxc✓� <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances ril the laws and <br /> regulations of the State ofYViscbnsin <br /> (a/ <br /> .............. <br /> .......E! / 5. . ....... <br /> or�I <br /> OWNER please print) CONTRACVOVAGENT <br /> ...71P..F...�..... .....R..t. ........ ............................................................................................ <br /> Q3 <br /> d i <br /> ADDRESS ADDRESS m <br /> ..ILI. .............. Q.I e .......N. .........J^�'.¢1�'� ............................................................................................ <br /> ADDRESS ADDRESS t <br /> ................................ . ..... ................................................................................. m <br /> P E PHONE T <br /> ... ............................................................. <br /> J <br /> PL MBER WELL DRILLER <br /> . ................................................................................ ........ <br /> .................................................................................... <br /> ADDRESS ADDRESS C Q <br /> 2 » <br /> ..............................................�. z ...................... n Z <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° c ° <br /> o <br /> h <br /> Batrooms 0 <br /> 1. Work: 2. New Building Details No. """"" i� i • <br /> New Building Type Co struction: No. Bedrooms ...�.:.... <br /> ........ <br /> Additionh l' yn^t" Septic Tank Size Gals. <br /> ...V...... ........ .............. ...... .... .. <br /> Sanitary ...Al... Size ...e�-.I..... ft. x .... ':. ..... ft. .......... rC <br /> Filling/Grading .......... Heigh <br /> t r.a.......... <br /> �Storie�s...fP.....X......a1......0�..... 4a. Absorption Field Site: <br /> Moving .......... Area P ...... Soil Type ........................... ........ (, <br /> o <br /> MODIIe Home <br /> Slope .......................................... <br /> Privy Perc. Rate ................................... <br /> .......... 3. Use (describeexactl , 1 -family <br /> .Wela< --fit.., home,garage, motel, - Dry Well .......... <br /> Seepage Trench Z <br /> Subdivision <br /> Camping Unit .......... .................................................... Privy pp.......... c <br /> Seepage Bed l6 <br /> Location of proposed structures and existing structures well sewage systems, roads, etc. should be sketched in Fig. A. I jz) Z ` :( <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at ;rJ <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ( !'1. <br /> ---------------------------------------------------------------------- t : <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — sq.ft. <br /> r <br /> 0 <br /> f <br /> 2. T AT <br /> \1 1 Z <br /> /yJ O <br /> m <br /> ((f� <br /> C <br /> MU) 'umr Dto co y <br /> 0 « Q < > > 2 � Sm <br /> m Na�< —' nm ani <br /> Cy > > ; <br /> om 2 o � m <br /> n <br /> o � = m <br /> rJ <br /> o A 70 <br /> x n : m <br /> ..... ...Yr <br /> ....................... .......... ................ .. ................ign uent Datear �U................................................................................................................................................. <br /> u, <br /> b : g <br /> .............................................................................................................. . . . <br /> o <br /> q e N OJ ON Inspection Date /�./.....................A.... .. .........?ranted <br /> . . ....I..:....`YS ..... .r. aor. .. ................ <n u, . oZoning Administr or m <br /> NOTE: A preliminary site inspection must be made and site approval on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 been 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 APPROVED. <br />