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Burnett County Office of Zoning Administrator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 4 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as — <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c Q <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n ' <br /> :..... MdN . ... o <br /> ............................ v:S .. � k/ <br /> .... ... ............... ................................................. <br /> N <br /> OWNER (please prin CONTRACTOR or SURVEYOR or AGENT — <br /> ..3d0 .• 6.�0 <br /> ADDRESS ADDRESS <br /> .. ........I................ <br /> ODRESSZoef}L ADDRESS............................................................................ <br /> a <br /> 6�.z .9..��. 7 ...............86 .-. �7� ...... <br /> ..............................................................................I........... Q <br /> PHO PHONE <br /> ...........I......... .... .......................................................... ............ .......................................................................... <br /> PLUMBER WELL DRILLER .T <br /> O <br /> .. . . .................................................................................. ............................................................................................ <br /> 0 n o <br /> ADDRESS ADDRESS 0 <br /> PHONE PHONE ' <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° �u <br /> h v <br /> 1. Work: 2. New Building Details No. Bathrooms .......... f�. o <br /> New Building X T No. Bedrooms :ey z �' <br /> g ype of Construction: Y S <br /> AdmeonSeptic Tank Size Gals. ... ... �� <br /> Sanitary ....I..... Size ... ... ft. x ...O.:e.... ft. ....•.•... <br /> EillingiGrading ,,,,,,,,,, Height���... S ories .. �,. 4a. Absorption Field Site: <br /> + y.,... <br /> Moving .......... Area ......../i'1t0 T Soil Type .................................... r <br /> Mobile Home .......... Slope .......................................... 15L <br /> Privy , 1 -family Perc. Rate ................................... <br /> .......... 3. Use (describe exactlywell .......... home,gars e, motel, etc.) Dry Well A <br /> P <br /> Subdivision j�,p�f/-4 � SeepageTrench <br /> , •,t7Lt <br /> .......... <br /> Camping Unit ,,,,,,,,,, Privy .......... <br /> 41 <br /> .................................................... Seepage Bed <br /> -------------------------------------------------------------------- c' i <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> T <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property Is located at a highway �mter <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING t <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. N' <br /> ------------ ---------------------------------------------------------- <br /> ak` <br /> 5. Lot Size: Fig. A. 6. Location: Cr <br /> Q ; <br /> ................ ft. x .............. ft.=... ........... sq.ft. ............................................................................... p : <br /> 560 <br /> e � <br /> N O <br /> O � <br /> 3 <br /> I O <br /> T <br /> J <br /> -- <br /> �� [ z Z <br /> 0 <br /> v <br /> -f>w a*v- \ <br /> M Z <br /> \ <br /> o <_ m : ` e � m Z o o' a <br /> o � aLin <br /> � 37 <br /> �o <br /> 1 <br /> oep :per m <br /> Signature of Owner or Agent Date <br /> X 77 <br /> Remarks ......................................................................................................................................................................... m m <br /> O <br /> w <br /> n <br /> ............................................................................................................. 1 . . . . . <br /> U <br /> Inspection Date ��JQi i �! uNi u o umi o u m <br /> p ....................................... ...... . ..�h. �...1..!:.... ... ............................................. ! <br /> Zo g Administrator 8 8 8 8 8 rn <br /> m <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 he 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 />