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Burnett County Office of Zoning Administrator W 7 c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 9 <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 ,$ M <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regul 'ons of the State of,Wi nsin. <br /> ........�.. Ula N..�......:,. .. °, �.IUS m <br /> ........................................ ......... .................. ................................................................. ....... <br /> n <br /> OWN (ppllans print) <br /> rn CONTRACTOR or SURVEYOR or AGENT <br /> .......*R*ESS ��.?...��:..................................... .ADDRESS.................................................................... ....... <br /> ADDRESS <br /> T <br /> ...........RES .�;........�.:.� .:: 44:...................................... . .................................................................................. ....... <br /> ADDRESS_ f ADDRESS k' <br /> PHONE ............................................... . .................................................................................. . 'OO <br /> PHONE .... i� ilk i i <br /> H- <br /> .......................................................................... ...................................................... ....... <br /> PLUMBER WELL DRILLER : L— <br /> :� <br /> ADDRESS <br /> ...................... "A' <br /> .............. ............................................................... ....... �, O <br /> ADDRESS 0 <br /> ........................................................................................... ^. < \ � <br /> n o <br /> PHONE . .................................................Y........................... o .0 <br /> PHONE • • » <br /> DESCRIPTION P r <br /> 4. Sanitary Facilities: ° o ° t, <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ••••••• <br /> o <br /> New Building ,,,, -, TyP�-�f Construction: No. Bedrooms ... ...... <br /> Addition .,, „••�-t':u.^e:.. •„ Septic Tank Size Gals. ... ...... c_ <br /> ........... 77r i <br /> Sanitary Size�!fi�./.� ft.x ...../.. ... ft. ... ...... " <br /> FllnnglOradino .......... Height....,..,.... Stories ............. 4a. Absorption Field Site:/L - E"' •.^L i <br /> ic1 <br /> Moving .......... Area .........5. >.,:....................... Soil Type ............................. ...... r <br /> Mobile Home .......... Slope ................................... ...... ;w <br /> o <br /> Privy <br /> .......... 3. Use (describe exactly,"! -family <br /> Perc. Rate ............................ ...... <br /> Well <br /> .......... <br /> home,garage, <br /> ara,geJ, mmotel .t f Dry W <br /> ell <br /> oSubd1.......... q n 1/ Seepage Trench ... <br /> lvieion <... . ...............Camping Unit Privy ... ..... <br /> ------------------------------------------- Seepage Bed ..... <br /> N <br /> . A � c <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at n FL <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection, <—. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. (� — <br /> _________________________________________________________ _ <br /> 5. Lo Si — <br /> q, FF,kk Fig. A. 6. Locati <br /> ...,I�....�.d.. ft. x .J..U...'. ft. — ..../ C..... l a.,c <br /> 9{� I I <br /> �< .. .... -�........ sq.ft. ..........1.... .. ....1...... .....C..........{..............7/ ....... f - <br /> rr. � <br /> O rt v <br /> Q, CoARGC t PRo.S'EP r, PO.' o <br /> / ScaeNof <br /> p0Ren / _ ' r 3 <br /> h <br /> I ` i <br /> r [ z <br /> U' .r <br /> p b <br /> SN7 N 'Z a <br /> m <br /> n <br /> Signature of Owner or A Wt I Dat } I g O <br /> Remarks ....................:. ^_..' 5.�'..'.!.r.ac ✓✓✓/,.. .f:.`. :a.........( ............. ..i�'..4.�....�• . 'r <br /> / U J <br /> � . <br /> ........ . . ... ............ .......1................... ........ t `, ilo r i. <br /> J /. .................... <br /> a . o <br /> o . . <br /> ............ o <br /> Inspection Date ....................................... / .....7..!.� .. ,..,............... . <br /> • • Zoning Ad inistratbr• ' $ $ $ $ <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 application 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 been 1 ssued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or 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 APPROVED. <br />