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t, <br /> Burnett County Office of Zoning Administratord o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 0 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 <br /> Ordinance, Sanitation Coddle, and <br /> with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- i� <br /> 1 �fttc.14So <br /> ....... A .............. .................5�� � ................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> R — ) <br /> ........�l.Q. ........... . .. ................................................ ............................................................................................ <br /> ADDRESS ADDRESS i <br /> S?. N..�. 2y......lN=................................ ............................................................................................ T <br /> ADDRESS ADDRESS <br /> S ...z2................................................ ............................................................................................ <br /> PHONE <br /> Yr PHONE <br /> .........f� .�.� 117 ...................................... ............................................................................................ \ (� <br /> PLUMBER WELL DRILLER <br /> iV O <br /> ......... .............................................................................. . . ....................................................................................... _. <br /> ADDRESS ADDRESS m <br /> n 0 p <br /> ........................................................................................... ............................................................................................ O <br /> PHONE PHONE <br /> Z r <br /> DESCRIPTION 4. Sanitary Facilities: ` 0 6 o r <br /> 1. Work: 2. New Building Details No. Bathrooms ../L :� o c, <br /> New Building Type ofstructLpy No. Bedrooms ..�.... pQ <br /> Addition ....,,,,.,, r' 1 M �. Septic Tank Size Gals. <br /> Sanitary ��,.� ft. � •••••• <br /> ... .. Size ...5.�..... ft. x .... .. i <br /> Filling/Grading ,,,,,,,,,, Height............. Stops ....�..�2.... 4a. Absorption Field Site: <br /> Moving Soil Type .................................... 't <br /> .......... Area ........1'.�r..1.Vie................ o i- <br /> Mobile Home Slope .......................................... •, i'1 <br /> Privy 3. Use (describe exactly, -family <br /> Perc. Rate ................................... ) E . <br /> Well ,.x.,, home,garage, motel, etc. Dry Well .......... f <br /> t : <br /> Subdivision .......... .................................................... Seepage Trench .......... E <br /> Camping Unit .......... Privy L 111 <br /> :� <br /> .................................................... Seepage Bed <br /> L <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched In Fig. A. Include road I <br /> setback, side and back yard dimension and location and setback from all bodies of water. It property is located at a highway inter- o_s <br /> section, show the intersecting highways and the setbacks required along them and at the. Intersection_ CLEARLY LABEL EXISTING Y_I y 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. y p <br /> -----------------------------------------------------------------___-- <br /> 5. Lot Size: Fig. A. 6. Location: v <br /> 4 <br /> RI <br /> ................ ft. x .............. ft. — ............................... sq.ft. .............................................................................., l f !• 7 .e <br /> LpkE <br /> FD. <br /> IN C ° <br /> T <br /> xw°�� <br /> '110 39 z <br /> SSp <br /> Q� loot —may <br /> s <br /> cnry mmz <br /> C d r C C N <br /> r0 N2. n � w' n m <br /> a in M m o m <br /> Z o o' <br /> 0 3 am 3 <br /> En — _ <br /> M <br /> G <br /> Signature of Owner or Agent Date o C <br /> X <br /> Remarks ......................................................................................................................................................................... .� m� <br /> m <br /> 1 u <br /> U <br /> 'T <br /> Inspection Date ....................................... m <br /> ..:..... .............. <br /> Zon.i ... .t.... 8 8 e. n9 <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 systerns, 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 Adm in istrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />