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arnetCCourfv Office of Zoning Administrator d 3 --I <br /> O <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT w <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '< H M :00 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m n <br /> Ordinance, Saltation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a Com` <br /> N ? <br /> S.d....(..................................... EL <br /> ............................ ............................................................................................ ^ <br /> OWNER (plea print) CONTRACTOR or SURVEYOR or AGENT of <br /> /).Qn... .. l.( (........t�tl�..,!.s....................................... �, •��� <br /> ADDRESS ADDRESS V K <br /> .......................................................................... .......................................................................... 3� <br /> ADDRESS ADDRESS � <br /> ........................................................................................... . .......................................................................................... <br /> P NE( PHONE <br /> . .. i ...`....................................................... . . ..................................................................................... `l/1 <br /> MBER WELL DRILLER <br /> 1 ' <br /> ............. 0 <br /> ADDRESS ADDRESS n O ~' <br /> :4 < ;� <br /> Z ? .P <br /> PHONE PHONE r. <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... i l� o <br /> .......... <br /> New Building .......... Type of Construction: No. Bedrooms 7 <br /> AdditionSeptic Tank Size Gals. .......... <br /> SanitaryY Size .............. ft. x .............. ft. .......... 3 N ? E <br /> y <br /> Filling ,,,.,,,... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ......................................... <br /> Grading Slope .......................................... ?{ i <br /> .......... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... ti i <br /> Privy home,garage,motel, etc.) Dry Well .......... --� <br /> Well ...�'rQ.f. �/�.!111. .�....... Seepage Trench <br /> .......... <br /> SubdivisionPrivy .......... <br /> .......... .................................................... <br /> Seepage Bed S� <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road It •� <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- fl• <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING Ipp"�� H• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. l p' <br /> ---------------------------------- ------------ <br /> 5. Lot Size: Fig. 6. Location: . <br /> ................ ft. x .............. ft. — ............................... sq.ft.t. ............................. ................................................. � <br /> 0 ^.1 0' <br /> o ?. <br /> 0 <br /> f <br /> s <br /> a <br /> I I � <br /> 1 � � p <br /> t� m <br /> 7 <br /> tC <br /> m <br /> L <br /> C m m <br /> m fA 0. C <'fD E• <br /> m N a a•c —,�;a <br /> p <br /> Z oo < t'n r <br /> O 7 <br /> Lqcn �c <br /> 40 <br /> Wi� ture o Owner or Agent Date ° <br /> X EiiEE <br /> Remarks ......................................................................................................................................................................... T i <br /> m <br /> ........................................................................................................................................................................................ ue <br /> ........ ..... .,.0.............. .. .................................... <br /> vt <br /> Inspection Date ....................................... cLr.?Lo l � k: ...'............. . 0 0 0 o vN <br /> 0 <br /> Zoning rni Istrator k� : 0; 0 0 0 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faci hies <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 />