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CA\ COD) <br /> nett CountyOffice W Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT v' 3 <br /> FC THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the wi)rk described and located as '< — o ':fJ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c ?. ) <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulationg of the State of Wisconsin. 3 CL i\tel <br /> /� rw a n� 0 <br /> /.I...F.n........... r vY! ......................................... .....................J..f ..�. ,...................................... N <br /> OWNER <br /> .-y(please print) ` '—y--1 CONTRACTOR or SURVEYOR or AGENT a <br /> ..../5....4..........I..........(ThQR l$PNr . . . . <br /> ......... ....................... .................I......................c......I..........I.................. <br /> ADDRESS ADDRESS .°'. ;` / <br /> ............. a :� <br /> ADDRESS ADDRE S ? <br /> p� 7i L <br /> � _S1 . <br /> PH/ l ................................................... PHONE i^�, J i <br /> �J)! . .. dQ . . . ..................................................................................... 'ted �� <br /> PLUMBER I WELL DRILLER <br /> ' h ' <br /> .......... <br /> ..... . . ................................................................................ ............ ..................................................................... \r O I <br /> ADDRESS ADDRESS <br /> G) <br /> n .� <br /> ........................................................................................... ............................................................................................ o .: <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: / R o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building Type of s ru tion: No. Bedrooms ....... <br /> Addition ,.. ,. N')"C ...... Septic Tank Size Gals. ... ... �\ . <br /> ....... .. ........ ........... ft. <br /> Sanitary <br /> ..2.°.... Size ..�.... ... ft. x ..... ..r.... i <br /> 4a. Absorption Field Site: i <br /> Filling/Grading ,,,,,,,,,, Height.... Stories �./.1....�-..17.. :\.) ' <br /> Moving .......... Area ..........r�L�j.0 .r.7..y- Soil Type .................................... h <br /> Mobile Home Slope .......................................... <br /> .......... <br /> Priv Perc. Rate ................................... <br /> Privy 3. Use (describe exactly 'famil 4 <br /> Well �5'...... home,garage, motel, a Dry Well .......... j <br /> Subdivision ,,,,,,,,,, Seepage Trench .......... 1•�1 <br /> Camping Unit Privy .. <br /> .......... ........................................ gg <br /> _____________________________________ ___________ Seepage Bed_______ <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 highway inter- NZi : C <br /> section, show the intersecting highways and the Setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --------------------------------------- ------------------------------- <br /> 3 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> / <br /> ................ ft. x .............. ft. — ............................... sq.ft. .C.4.s?....h.E..t...`.........�..�..r...........�.�............... <br /> Plve- <br /> N �' p <br /> 0 <br /> I � <br /> f fU <br /> o <br /> on <br /> -------------- <br /> lt <br /> 0?# as <br /> /1 7��j CiF j <br /> par- *.m m m m <br /> � m ani <br /> m n n m <br /> + ; o <br /> z <br /> Slgn2fj of Owner or Agent / Date `, - <br /> -) ,/ j <br /> Remarks . .may/.�1.... -J. ': ....G rL: . ................................................................................................................... m m <br /> � u <br /> . ......... ... <br /> it <br /> G.'. . . . . ,ovnin. ._................... .... ....... . ..... . <br /> .U <br /> mInspection Date) .................` <br /> .. ......... Z <br /> dministrator $ 8 VJ <br /> o o <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving ani tan Ye. iliti •s <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test mu t be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumhing o start any Budd <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the 'infori-ndtioi, conveyed here <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zonn j Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND A PROVED. <br />