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Burnett County Office of Zoning Administrator C 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and lo c ted as 7 -^ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use � c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wls onsin. a <br /> C ...5..,.Toh..n �.................... ....Ir..K..�..... rac ice.................. ....... - o <br /> 3 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> l grief-... ,l.P,��:.n.�....... - <br /> ............... ............ .. . .... ... . ...... a <br /> ....... d <br /> ADDRESS ADDR SS � � -I'r <br /> ........................ . ... ....... .... ...... . .... ........ ....... . . ix....... q.. ... .. ..... .. .. <br /> ADDRESS ADDRES <br /> .e , ... .... �a3.. .. ...... <br /> PHONE PHONE <br /> ........................................................................................... <br /> PLUMBER WELL DRILLER <br /> O v` <br /> ADDRESS ADDRESS <br /> 0 <br /> C)........................................................................................... . . . . ........................................... ........................... .......... o' ,`.• <br /> PHONE PHONE Z ` <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building No. Bedrooms ...... <br /> ..... .... Type of Construction: ... <br /> �o <br /> Addition Septic Tank Size Gals. .......... � <br /> Sanitary Size ft. x ft. """"" <br /> Fillingl Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ......................... .......... r <br /> Mobile Home Slope ............................... .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ........................ .......... <br /> Well .�.. J, ,., home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... <br /> CampingUnit .......... .................................................... <br /> Seepage Bed .......... <br /> ------------------------ <br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc., should be sketched in Fig_ A. Inclu to road Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- d <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EX STING <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> __________________________________________________________________ ___ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... s4.ft. ................................................................... ........... <br /> Iron. i � <br /> Pars <br /> 0 0 <br /> - - o <br /> I <br /> 0 <br /> 0 <br /> ( is <br /> IJid �I`) 1�/ <br /> -' <br /> � Z <br /> 0 <br /> t m <br /> 77 r a :E m m Z <br /> 0 (' J < N_ J C N <br /> yj _ F <br /> � N _ � d ¢ m <br /> c � <br /> Z C) . D a M <br /> Ci <br /> arr <br /> g aq-.. .. �= <br /> ...Ow........ner...or.....Aent..g.................................... ................bate <br /> . <br /> Signature of :�o C <br /> X S <br /> Remarks ......................................................................................................................................................................... T M <br /> tar <br /> ........................................................................................................................................................................................ — <br /> ....................................................................................................................................... . .......... .................................. <br /> /Jn :�. <br /> rr <br /> Inspection Date ....................................... ..... ...... ...! !..� .. :qq N . a u, <br /> .O <br /> ... ..... ....... to oiou <br /> Zoning Administra r 8 8 8 8 8 8 c/. <br /> NOTE: A preliminary site inspection must tie 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 percolatioi test must be attached to <br /> this application before a permit will Be issued. Do not purchase or install a septic tank, do any pl tr 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 be made without approval of he Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />