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Burnett County Office of Zoning Administ ator 0 0 <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 loci ted as < µ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County LaAd Use T c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin 3 a <br /> .OM MI ...�G.f. P.Sd . 1,.c..�Qq.C1.G ............................................................................. .. N o <br /> WNEE (plea rind n CONTRACTOR or SURVEYOR or AGENT m m <br /> .5.. .. 1l..Y... .......................................... <br /> ...... . .ADDRESS <br /> ........................................................................................... <br /> ADDRESS <br /> ADDRESS � <br /> ....................5... ............................. ............ ...................................................................... ........ <br /> ADDRESS <br /> I ' ADDRESS <br /> .1, Q..�y.:..... .. .................................................. . ................................................................................. ........ <br /> i <br /> PHONE PHONE t ; <br /> PLUMBER WELL DRILLER � <br /> ADDRESS ................................................................................... ........ <br /> ADDRESS n' M <br /> ........................................................................ o <br /> .. ................ PHON..E....................................... .............................. ........ <br /> PHONE <br /> DESCRIPTION o r <br /> 4. SanitarYFacilities: o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details .. <br /> o <br /> New Building Ty of Construction: No. Bedrooms . ........ <br /> m <br /> Addition ,,, , rc-.v-v-.C.� Septic Tank Size Gals. . ........ <br /> ..... . ......... GG <br /> Sanitary .......... Size J...�R...... ft. x ...: ft. . ........ <br /> Filling/Grading ...,.,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area . . . . .. Soil Type ........................... ........ <br /> r <br /> o i <br /> Mobile Home .......... Slope ................................. ...... . .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .......................... ........ <br /> well ,..,....., home,garage, motel, etc.) Dry Well . ........ E ` <br /> Subdivision Seepage Trench ' <br /> 1€ <br /> Camping Unit •......... Priv , ........ <br /> .. .�.u.;.r��ccaam.�t...K.;.i:�....r y <br /> _____ Seepage Bed ........... <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig A. Includ road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a--rrr�� <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING I S.l" <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ' `—' <br /> ------------------------ — <br /> _ – o <br /> --------------------------------- ----- — <br /> __ <br /> 5. Lot z �7T Fig. A. 6. Location: <br /> ....� .. ft. x ...� .. ft. — .1..........1`c sq.ft. C ' <br /> ...................................................................... C - <br /> a <br /> O � <br /> ^ 1 s 0 <br /> 1 <br /> t d � <br /> SP O Z <br /> o <br /> v <br /> to Z <br /> (Nl1a C 'C d c <br /> N m <br /> p o m <br /> va _�m 3 <br /> 0 <br /> u <br /> m <br /> Signatureof 61wner or Agent Date ��n,. C <br /> Remarks ..... ........ . . ... ... . . .. .............. ....................................................... .... — <br /> "I X 70 <br /> ... . .. .... .. .. ..... ......... <br /> „ m <br /> �r� <br /> ..... �n.............. ...... ..e�m,.: .... .(�.0 <br /> ..... ... <br /> I' <br /> Inspection Date .......4.4... T� ...w............ o o U m <br /> . . .. ..... ............. ... ...\. g y m <br /> Zoning Administ a r 8 8 8 8 W <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving san i tar fan I, - •s <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 not purchase or install a septic tank, do any plain [)Ing 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 fie made without approval of tri Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />