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Burnett County Office of Zoning Administrator d 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 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use n c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 0 <br /> 3 n <br /> OWNER(please print) �— '! t . N <br /> � $ � <br /> CONTRACTOR or SURVEYOR or AGENT m,� / <br /> S.. ....... ...... ..... a.X......... .� a ' ; <br /> ADDRESS ADDRESS <br /> t m <br /> .�w..6k.r..7r.......W. ............ ..5/.P..3.o........... _ <br /> ADDRESS ADDRESS <br /> ........................................................................................... ............................................................................................ <br /> PHO PHONE y <br /> N.��O fT in f °rl <br /> PLUM ER WELL DRILLER <br /> p1 <br /> ADDRESS ADDRESS pr'J <br /> .......................... . ... . . ...................................................... . . . . ......................................................... .. <br /> ......... . .. <br /> . ............ o' <br /> PHONE PHONE Z H m � <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .. o <br /> New Building ....,,,,., Type of Constructi n: No. Bedrooms ...a ., <br /> Addition .... ..... ,,,......--s •,ICl, /;/,yi... ......... .. Septic Tank Size Gals. .......... <br /> Sanitary Size .............. ft. x ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: ; <br /> Moving .......... Area Soil Type .................................... iq o <br /> ........................................... .......................................... Imo. 0 <br /> Mobile Home ,,,,,,,,,, Slope <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well .......... home,garage, motel, et . Dry Well .......... ti <br /> Seepage Trench <br /> Subdivision • ••• 9in <br /> Camping Unit .......... .................................................... Privy <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 /> Q <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- ��710_ ;'d� L:- <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING :y al <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. l� o' <br /> -----------------------------------------------------------—————————— ;G <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. .............................................................................. 4. <br /> . <br /> a <br /> /J <br /> N O <br /> O � � <br /> 0 <br /> A � <br /> ;N O. <br /> :V <br /> 21 <br /> n (C'0 71 <br /> M N r- -a0 m <br /> anC� cm <br /> m <br /> o y n <br /> oZ oma ; nam 77 <br /> 0 70 <br /> m <br /> ............................. ...................................... o p <br /> Signature of Owner Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... m <br /> to ' <br /> ........................................................................................................................................................................................ — <br /> ................................................................................................................ �: . . : . . . <br /> 1i <br /> Inspection Date ....................................... ..... .. . .. ✓,FGF........ ... ....... . Pn o N m <br /> .00 Zonin dministrator 8 8 $ 808 8 yr <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 made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />