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0) ) c �' "Up <br /> , <br /> Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT X <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the C� <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 (J <br /> regulationsof the State of Wisconsin. <br /> .. . . ............................................. ....... , <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> .....gie m.u�'? ....A.n�...3........�... <br /> ........... ....................................................................................... <br /> ADD SS ADDRESS <br /> tlr. 0S0fL :L Mill.. .. ..................... ................................. ........... ................................................................................ <br /> ADDRESS . .. <br /> ...... d^ <br /> Cn <br /> ADDRESS t '� <br /> . . ..................................................................................... .................................................................................... ....... P - <br /> PHON �.1 <br /> ........ < ............................ PHONE <br /> p �• ;��...!''...:...�. ..kms:. <br /> PLUMBER WELL DRILLER <br /> ...... ........ <br /> ADDRESS ADDRESS 0 C <br /> ^_. < <br /> ........ <br /> ........................................................................................... . .................................. Z <br /> DESCRIPTION 4. SanitarY................ ............. <br /> . ........ o� :�, <br /> PHONE PHONE........ <br /> Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms . ..�.... . <br /> New Building ....'6.. Type of Construction: No. Bedrooms . . ..... j— <br /> Addition a Septic Tank Size Gals. <br /> Sanitary ...,X... Size ...�24... ft. x .� � ... ft. "'-' 3a <br /> Fining/Grading ......0... Height.....S..... Stories ....1..... 4a. Absorption Field Site:c <br /> Op Soil Type ...................a .. o <br /> Moving .......... Area ............... .�M p................. 7. ..... (:.S O <br /> Mobile Home Slope ............................."r,`. ' <br /> .......... ' <br /> Privy .•........ 3. Use (describe exactly, 1 -famil Perc. Rate .......................... . f.... <br /> Wel ' ........We9J <br /> well ,......... oma,garage,motel,etc.) Dry Z <br /> Subdiv <br /> --Campilalon-- --- Seepage Trench o <br /> .......y ....o.......... '.............. 0 fir. <br /> Privy <br /> Camping Unit .......... ....L.I':.tT7YI�.. ...LJLJ.LL`r�........... Seepage Bed ��. Z...., .� z <br /> -------------------------------- �. <br /> Lo <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. rpF <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at :r,� <U b v <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. :G. Z<-• <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. .I i 0 <br /> ---------------- - <br /> 5. Lot Size:. /� �Q O Fig. A. 6. Location: / J, � � fN <br /> ft. SQ... ft. - ...i.. ...... ............. sq. ft. v�In.G:.RI�L ..(.-.D....:........ ... ... O <br /> IN O <br /> 0 <br /> ' T <br /> Z <br /> � 1YLALI) DaAJ= k> M <br /> rsI M <br /> 1n <br /> nMID 0 > <br /> nHQ < o 0 o — _. In <br /> m moo.•< — o- m nny <br /> 00 O m 0 <br /> Z�.O > <br /> o c m <br /> 6n <br /> In <br /> Q <br /> ( <br /> ..... .. .. .. ..... ... ..K.�C'.> ...... .......... .... .. .... 4D.tSi ature ofOwner or Agent o <br /> Remarks . :... .. . .........'...'.E: ..................................................................... ...... <br /> .................F.,C::.c:.... -UL•�� 4:C(cS,? :`...::zc.................................................................................................. ...... <br /> ....................................................................................................... ... ................... .. .....-:76 <br /> .. ...... <br /> .. ................ ... <br /> Inspection Date .:s. ..1.:-..r....��....:.... .... .....mQ"a.... ..... ..�aM.. Kill,. <br /> Zoning Administ or 8 8 8 8 $ 8 tmii <br /> NOTE: A preliminary site inspection must be made and site approval granted 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 apr lication 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 be in issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans o 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 PROVED. <br />