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Burnett County Office of Zoning Administratord 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO TWE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� O <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 :h <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a .\O' <br /> ......0Af.F.....P.. 4R,Sc�.N..................................... ............................................................................................ N o� <br /> OW ER (please print) CONTRACTOR or SURVEYOR or AGENTa <br /> ADDDRESS N <br /> . DREi. .......................................................................... AD....... .............................................................................. a �: <br /> DRES......S <br /> wEt�sr .f.�tJ�S,. 5:Y...... .... ............................................................................................ <br /> ADDRESS ADDRESS �-f:�1 <br /> ........................................................................................... ............................................................................................ "1 <br /> PHONE PHONE <br /> C� .(1.....U...`-���/IIS. .. ............................. :a, w <br /> PLA BER WELL DRILLER <br /> f .'�.. iJs/`. 1Q.1.G�1J5:.. ............................................................................................ <br /> ADDRESS ADDRESS <br /> . y6.: o <br /> Al) <br /> .............. ......................................... ......................................................................................... <br /> PHONE PHONE ' <br /> Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: No. Bathrooms — <br /> 2. New Building Details ••••%••• <br /> R: <br /> New Building Type of Construction: No. Bedrooms .... d m <br /> Addition Septic Tank Size Gals. %JQ :O <br /> Sanitary ... Size .............. ft. x .............. ft. .......... <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: NA <br /> Moving Area Soil Type ..In'll SNS :l r <br /> .......................................... <br /> Grading Slope ........��t!'. .()................. ... : .* <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ....11.......................... ;I <br /> Privy ......I... home,garage, motel, etc.) Dry Well .......... r <br /> Well ....I..... Seepage Trench .......... <br /> ................................................. .. <br /> Subdivision Privy d �......... i <br /> SeepageBed 7//C...'------------------------------------------------------ <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- 4 °- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ry y <br /> ----------------- -- -- ----------------- I V <br /> 5. Lot Size: Fig. A. 6. Location: it o <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> CnA <br /> 5Fk A7T14C H F-4 ' <br /> o <br /> fi <br /> i\: .T <br /> Z <br /> O <br /> 7 <br /> M c -u: W Z <br /> m N Cr a- <br /> < <br /> a vtN' y < <a � m <br /> Z o . cD `�° '' <br /> O oo <br /> O <br /> criO <br /> � a <br /> ........ .�... <br /> / ... ......... 17 <br /> e <br /> w 0 <br /> , <br /> Signature of Owner �ate X <br /> Remarks 4� ./Ud..�;. T 0 <br /> - <br /> m . <br /> ................. ............................................................................................................................................................... -- <br /> � s �, ........................ <br /> ............. ...... ..... ..... o <br /> / T <br /> Inspection Date .4. .x.7... 3 CZi�rC�/ :u, 0 0 0 0 o cn m <br /> :................... <br /> . . . .. ............................... b00000m <br /> Zoning Admin sf trator o 0 0 0 0 o V) <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 />