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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 m <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wls6nsin. a iOQ <br /> K A ^1H 0,; T I <br /> OW NERj(plees Intl T ,;�:J CIV......................................... . SURVEYOR or A <br /> CONTRACTOR or u_,J CONSTJCONSTI1�... N <br /> GENT m <br /> OUT ; 7 B9 BGS 71 <br /> .......... .. ....... ....... ..... ......... ..... .. <br /> .. <br /> ADDRESS ADDRESS <br /> "I 51!T71 <br /> ....................... ............. ................................................... <br /> ADDRESS ADDRESS <br /> 715-655 7595 09 <br /> :......... . . . ......... <br /> PrIONE PHONE <br /> PLUMBER WELL DRILLER <br /> ADDRESS .... ................................................ ............................................................................................ <br /> •DESCRIJ 1 `iFOG.a.'.�::i ,'rI •b8Gl ADDRESS................................................................... <br /> 0 BO::.. .Z .......:........ r............5' o 0 <br /> PHONE PHONE Z N r' <br /> PTION 4. Sanitary Facilities: o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Construction: No. Bedrooms L....'J.... a <br /> m <br /> Addition Septic Tank Size Gals. 10.0.0 )) <br /> Sanitary ...t.`c.... Size .............. ft. x .............. ft. !L......... E <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type ....................... . <br /> .......... ........................... . . . . .. .......... o <br /> Mobile Home .......... Slope .................... .......... .......... .» <br /> Privy Perc. Rate ........................ .� <br /> .......... 3. Use (describe exactly, 1 -family ; <br /> Well .......... home,garage, motel, etc.) Dry Well <br /> subdivisionSeepage Trench ......... <br /> .................................................... <br /> Camping Unit .......... Privy <br /> .................................................... Seepage Bed s, <br /> ----------------------------------------------------------------------- <br /> Location <br /> ----------- -----------------------------Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched In Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwaN inter- i 4 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXI6TING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ------------------------------------------------ ----------------- <br /> / ^ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ....................................................................l.......... C� E <br /> S ATTOI LL SH.-_;T Vra <br /> 0 <br /> I <br /> N <br /> I <br /> E <br /> I <br /> I <br /> 0 <br /> � s <br /> /J <br /> z �— <br /> I <br /> I <br /> < to Z <br /> N <br /> .a an °' C.` m S cm -0 <br /> m <br /> p m n m <br /> n o 7] <br /> I C, a� 3 <br /> a <br /> ......................................................... ............ . .............. o p <br /> Si nature of owner r A ent Date _ <br /> Remarks ......... ........................................................................................................................�....... ,� 0 <br /> m <br /> .............................................................. ...... <br /> ................................................................................................................. .. ................ .. .......... ......................... ....... \ <br /> Inspection Date . ... . . . �/ <br /> ................... CGO ll U ci, C a G u m <br /> .......... . ............ . ... . . ...............Ir...... m <br /> Zonin Ad strator 8 8 S 8 8 n <br /> NOTE: A preliminary site inspection must be made and e approval granted on all structures i volving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatior test must be attached to <br /> this application before a permit will be issued. Do not purchase or Install a septic tank, do any plri or start any build <br /> he - <br /> Ing until a permit has been issued. A permit may be revoked if misrepresentation of any of tIn Intonation 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 NAND APPROVED. <br />