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Burnett County Office of Zoning Administrator p o Z <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 •� <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 /> j'512 G� / <br /> � r... IcIPo- H O&� .... .......�:................... ...... .S.................................... <br /> OWER Peaa <br /> print) ,.�1 CONTR CTOR or SURVEYOR or AGENT a V <br /> p......!..............5 N....................... .......... r<c..l�u.!......�..3..... .X43..`.......................... <br /> ADD E S ADDRESS <br /> (� <br /> .... c•fC. iC.`!j.Fh....:..:''......��......................... ............................................................................................ r' `C_ <br /> ADDRESS _ <br /> ADDRESS�L t 0 V <br /> ..............'...3.9..........:c..r..q.............................. ........................................ <br /> � . <br /> PHONE PHONE <br /> ........................................................................................... . . . ..................................................................................... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... ..A..DD.....R...ES................................................................................ <br /> ADDRESS S 0 <br /> 0 <br /> W <br /> ........................................................................................... ............................................................................................ O .i <br /> PHONE PHONE Z N , <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .......... i o s <br /> New Building •,,,•,,,,, y f C . str®coon: ., No.Bedrooms .......... a ••� <br /> p <br /> Nop r ^Jr'G'`�t !�w Septic Tank Size Gals. .......... p �O <br /> Addition ...... . ..........,,.../...........Gr...... ...... . . <br /> Sanitary .......... Size ..i 7........ ft. x ......... ft. ••'••••••• <br /> Filling/Grading .......... Height......0..... Stories .../.......... 4a. Absorption Field Site: . <br /> Moving Area .......... Soil Type ............................. ...... <br /> O <br /> Mobile Home ........ Slope .......................................... .. <br /> .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Parc. Rate ................................... t <br /> 1e ga age, otel, etc.) '• <br /> Well ho Dry Well .......... F <br /> Subdivision ,,,,,•,,,, Tx.«.,!f ,,,�, Seepage Trench .......... <br /> ................yy' <br /> Camping Unit .......... I .................................. Privy .......... O <br /> .................................................... Seepage Bed .......... <br /> ---------------------------------------------------------------------- W rn <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road r <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ;1 Q <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ^1 �'" N' <br /> ----------------------------------------------------------- ---------- {O <br /> 5. Lot Size: p Fig. A. 6. Locatio <br /> ................ ft. x .............. ft. — ....�.�..'.�?.h... U°E! 1q.ft. ° .................................................`Gu♦ .S E i <br /> ........... . ............ <br /> N P <br /> \ I 3 <br /> l <br /> 01 <br /> OU Z <br /> M <br /> 'y (� <br /> �. N n• .A .. r. � N r 9 fn m 2 <br /> Q f <br /> -o cNira C� m s <br /> � m <br /> c � Dam <br /> Z o o n � 70 <br /> 1 Z. o Fpr lo <br /> a nm 3 <br /> ,(✓ <br /> r" -. .................................... r ` M i� ......... <br /> OSignature C <br /> Owner or Agent Date <br /> X <br /> Remarks .........................................................o....L.......fi..r.....................'................ 5 �``. �..o...f <br /> In <br /> ... <br /> Cie....................... ...... <br /> ............... wWkt......aee..... ............ ..... ........................ <br /> w: �... .r...... j-... - o <br /> z�/9� f t ... OGG �� :V <br /> Inspection Date ....................................... ................ 0: m <br /> Zoning Administrator 8 8 8 8 88 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 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 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />