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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> < - 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as -a w, <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 4 <br /> w o <br /> . .......................................................................................... J <br /> Steven..Dur.acid.................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT 0 <br /> a ++ <br /> 7.6 9 40..20 0th..St.....E.......................................... . .......................................................................................... <br /> ADDRESS ADDRESS <br /> ....................................... . .......................................................................................... '•m <br /> 'tj <br /> ADDRESS ADDRESS <br /> ' d <br /> ( C <br /> ........................................................................................... PHONE <br /> PHONE4-4 <br /> ........Donald... anieig.................................................. . .......................................................................................... f.�q <br /> a <br /> PLUMBER WELL DRILLERf <br /> Bex..W..............s. .ren.,...Wx.....5.4V.2.......... ........ . .......................................................................................... <br /> ADDRESS ADDRESS <br /> .. ......7.15-.463-2333....................................................... . .......................................................................................... I o' <br /> PHONE PHONE OZ <br /> DESCRIPTION 4. Sanitary Facilities: <br /> No. Bathrooms ••• <br /> 1. Work: 2. New Building Details w <br /> New Building .......... Type of Construction: No. Bedrooms . 0 ... <br /> Addition Septic Tank Size Gals. 7.550..... <br /> Size .............. ft. x .............. ft. .......... <br /> Sanitary ....X.... 4a. Absorption Field Site: <br /> Filling/Grading .......... Height............. Stories ............... ;(n <br /> SoilType .................................. . <br /> Moving .......... Area .......... .............. .... ............ :v r <br /> (D O <br /> Mobile Home Slope ............................1.eY.£a... .i :U .. <br /> Fare. Rate ..........................3....... :m <br /> Privy .......... 3. Use (describe exactly, 1 -family Dry Well 1 <br /> s <br /> home,garage, motel, etc.) <br /> Well .......... 9 9 • .° •C' <br /> Seepage Trench !p, <br /> Subdivision .......... .................................................... <br /> Privy m <br /> Camping Unit .......... .................................................... <br /> Seepage Bed X....... <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road i, a <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 i0 v; 's�Jfy <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O <br /> ______________ ___ r.. , <br /> ----- <br /> 5. Lot Size: Fig. A. 6. Location: At ;Nts <br /> i <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... ` m <br /> 0 <br /> a <br /> N O . <br /> O J <br /> J S- <br /> � fN <br /> O <br /> See atached -H <br /> 0 <br /> f <br /> J <br /> `7 <br /> T <br /> to <br /> (.t <br /> � w <br /> iu <br /> m N w m cm m <br /> _. Na C,� N <br /> Cr < N •G �p <br /> Z 00 <br /> O J O t0 3 <br /> 0 ? �T <br /> 0 W <br /> /�3 [ �� � m <br /> .... .. .............................. .......... ...... .... . .... o <br /> Signature of Owner or Agent Date X <br /> l <br /> m <br /> Remarks ...... . ... . .................... .............................................................................................................................. <br /> m <br /> E <br /> ........... .......................................................................................................... .......................................... ...�... . ................ ...... ............... . .... .......... <br /> .y <br /> – Z- b'S .�.. .. .. o o � 000Um <br /> ...... .............. <br /> Inspection Date . ' ' """ :J� c 8 8 8 8 8 m <br /> "" """ tt// Zoning Admi Istrator zCJ o 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 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 m ide without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />