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Burnett County Office of Zoning Administ ator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < 7 <br /> shown herein, The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lard Use 0 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisc nsm 3 as <br /> as <br /> Liz k <br /> V.tr.. !.a.!.a.....!....!.n... .......................�........:P`.L............. ................................................................................... ........ <br /> OWNER (please print) CONTRACTOR or SU RVEV OR or AGENT a p l.i m <br /> .. . ..... .... . ........................ ................................................................................... ........ a <br /> AD.9RESSgg ADDRESS <br /> v.U,p n O <br /> I ADDRESS i °s <br /> A ,RE 93 c <br /> ..HOqpN/E� .��...........�.............r................................. .PHONE................... . .. ........................................... ...... <br /> /V . ...... ...................?...{�.......................I............... ..................I........ . . . ... .. <br /> PLUMBER WELL DRILLER <br /> r f <br /> ADDRE .. .. ................................... ADDRESS n o <br /> c 6.. . c o �.. .. <br /> ....................................................................... ......... o <br /> PHONE PHONE Z N <br /> DESCRIPTION 4. Sanitary Facilities: I o 0 1 <br /> 1. Work: 2. New Building Details No. Bathrooms o 1 <br /> New Building Type of Construction: No. Bedrooms .... la <br /> Addition ....................................................,. ,,,, i Tdnk Size Gals. .. ...... <br /> Sanitary ......... i <br /> .. .... Size .............. ft. x .............. ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................... ............... Soil Type .......................... ......... <br /> Mobile Home <br /> Slope ............... ................ ......... _. <br /> Privy ,,,,,.,.., 3. Us describe exact) -fa Perc. Rate ....... .... ............ ......... <br /> Well .......... om , garage, motel, etc.) Dry Well ......... i <br /> ...... <br /> Subdivision Seepage Trench ... i <br /> .......... . .............................................. <br /> Camping Unit .......... Privy ....•.... Q <br /> .................................................... <br /> Seepage Bed . ...... G0 <br /> ---------------------- ------------------------- --- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched in Fig. A. Includ road Al�s <br /> etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwa inter- o section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXI TING � Y <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --------------------.—__—_—___—_—_-------_----------------------_-- `fi T <br /> 5. �%idiz�ii Fig. A. 6. Location: :� <br /> U............. ft. x .............. ft. — ............................... sq.ft. .................................................................... .......... C <br /> `P <br /> N � <br /> n <br /> IN o <br /> in ^rs N <br /> q ? o <br /> N <br /> I 4 � <br /> Jnll1 X� <br /> m� U. <br /> 0 <br /> 7J V19v� m Z� <br /> C . <br /> d <br /> m N a nd 4 m <br /> 'O Ul < ,� ,n c � <br /> O m D n m <br /> Z 0 0 n Ej M <br /> .0 0 n n 3 <br /> I �•Kl0 ? <br /> ... . . . . . . v .. . 5 � <br /> .....�.........�...�...�.... <br /> ............. . .e........... ... ...... ...... ...... .. `.-... ...... <br /> Signa o O <br /> of Ownell A ent Date — <br /> Remarks .. m m <br /> .........................................................................................................................:.................................................. ... ...... <br /> c _ <br /> o <br /> II <br /> ...........—.......................................................................................... .. ....................p.......9... .................................. ...... <br /> Inspection Date ...J�—..�.F.... ..� ..... .... X�:fUr. u oao m <br /> Zonin Adminis r; r�stt'l g o 0 o g o rn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures it volving Sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatlol test must be attached to <br /> this application before a permit will be Issued. Do not purchase or install a septic tank, do any pit tubing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the In ormation conveyed here <br /> with is found to exist. Changes in plans or specifications shall not he made without approval oft ie Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />