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Burnett County Office of Zoning Administrator eZ <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE - BUILDING PERMIT a' 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as oo .R1 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseC <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a i i <br /> 0 A) <br /> . ....................... ............................................................................................ _ <br /> OWNER (please print) CONTRACTOR or SURV EVOR or AGENT m C i O <br /> 7'iLLS,BdR�/ ld. So , a <br /> .. . ... ........................ ............ ....................................... . <br /> ADDRESS ............................................................................................ a <br /> ADDRESS ' <br /> Av.....-s.:ya 3to <br /> ADDRESS ADDRESS i <br /> ....................................................................................... ... <br /> . .......... ............................................................................... <br /> PHONE <br />( PHON <br /> ... ............................ ....................................................... <br /> PLBERWELL DRILLER........................................................................... <br /> .. .. ..........I...... <br /> � <br /> Q v�f ' <br /> .... ............... .................................................................. .ADDRESS............................................................................ � PJ <br /> ADDRESS — <br /> m 0 <br /> ........................................................................................... <br /> n O <br /> PHONE .............................................. : o <br /> PHONE ,3 <br /> DESCRIPTIONo <br /> 4. Sanitary Facilities: o <br /> 1. Work: No. Bathrooms / I71 <br /> 2. New Building Details •• ••••• <br /> New Building ,. No. Bedrooms <br /> Type of Construction: �.. � 0 <br /> Addition , . .. ., /�Q •v. `C Septic Tank Size Gals. f ....... <br /> . . ............ .................................... .. <br /> Sanitary ....<. Size ...a.fR.... ft. x ....u,p... ft. � � '� <br /> Fiilingf Grading .....•.... Height............. Stories ............... 4a. Absorption Field Site: \ q� <br /> Moving Area Soil Type .................................... :4r i <br /> Mobile Home ..... .... Slope .......................................... N :b+ <br /> O <br /> Privy ,� 3. Use (describe exactl , 1 -family Pare. Rate .......................:........... 3 <br /> Well k/ home,garage, motel, Dr Well a <br /> .......... ..•..... , i <br /> F <br /> Subdivision !UA[ D r 8/�$f M x(J Seepage Trench ........ . !e +t <br /> .... ..... ... ...................... ....7.. <br /> Camping Unit .......... Privy :C <br /> -------------------------------------------------- Seepage Bed /O.-- �o A M <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road e <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ;(' <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING i� H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o� <br /> -------------------------------- <br /> -------------------------------------- m <br /> 5. Lot Size: Fig. A. 6. Location: p <br /> .%Q..0..... ft. x .Z.g.�... ft. - ............................... sq.ft. ............................................................................... -- <br /> L W :✓r <br /> N �K O <br /> i �0 O] <br /> IZ ,/p 'JJ •�• i t6 <br /> �—75' o <br /> 1— f <br /> { a Z <br /> 3, 6-6Fr ° <br /> J <br /> C 0 <br /> v m <br /> m c a d rp <br /> m <br /> o l as 31 <br /> F» - 3 <br /> R,. o <br /> �'a7 "Si nature-o-1fTLO-, %� � v m <br /> •. ................ <br /> C <br /> g wne r Agent Dao• o C <br /> X <br /> Remarks ..� �r G�"U m m <br /> .... .... ......... .... ...... ...... <br /> .................................. .............................................................................................................................. _ <br /> .............................................../..........`....................................................... .. ...............�....-%/�/Z. ................................................ �G ' <br /> In <br /> Inspection Date ..(t"....�-.�G....kl...`.ti...� y i 'e: u�r o u o m <br /> o: <br /> .. ..... ..... . .. . 9....... .... ............................... <br /> Zonin ministrator $ $ $ $ g g y <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 lie 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 />