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Burnett County Office of Zoning Administr itor I? <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT »' 3 <br /> a <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describe and : J'e <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the n c <br /> :< <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the law and 3 -- <br /> reg letioris of the State of Wisconsin. <br /> .a. ..e. .........6... .s�. ................................ . ..................- . ... .. .................................... ....... a <br /> OWNER (please print) II CONTRACTOR or SURVEYOR or AGENT �" y ' <br /> c h n1 <br /> A DRESS / ADDRESS m - in <br /> �ve-*k f " .4.f. ....... L L....... <br /> ............... . !� <br /> ADDRESS . ..... .ADDRESS.................................................................... . � <br /> s <br /> .. tx <br /> PHOLLF PHONE <br /> ... ...................................................... . . ........................................................................... .KUMBE . ....... <br /> WELL DRILLER <br /> .lam <br /> lam, <br /> ADDRESS ADDRESS �J ' <br /> .................................................. ......................... NP � 4fe o <br /> PHONE ir't< PHOE...O.. ............................................................ ....... :Z <br /> DESCRIPTION pc 2ti5' 4. Sanitary Facilities: ° o <br /> 1. Work: rt No. Bathrooms <br /> 2. New Building Details •• -•• •• p � <br /> New Building + T No. Bedrooms 0 <br /> .......... Type of Constr n: .. <br /> Addition , , .--Q. . , S• • - -y,,,,,,• Septic Tank Size Gals. .. ... . . ' <br /> .. . ..... ... . ....... .... <br /> Sanitary ... Size ..... .. .ft. x ...7...... ft. ...Z. _�i <br /> Pilling/Grading .......... Height.. ..... . Styries ............... 4a. Absorption Field Site: ' <br /> �{ <br /> Moving .......... Area .., P. ......�. a ....... Soil Type ............................ ....... <br /> • r i <br /> Mobile Home ......... Slope ........................ :-C <br /> .......... .......... . ..... <br /> o <br /> Prier 3. Use (describe exac -family Perc. Rate .................................. <br /> .) Y .......... <br /> Well .......... home,garage,motel, Dr Well <br /> Subdivision .......... .................................................... <br /> Seepage Trench ... ...... <br /> Camping Unit ,,,,,-.,., Privy <br /> ------- Seepage Bed <br /> ------------------------------------ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. J �f <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is local d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. iii <br /> _______________________________________________ . ;ci <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ....................................................................... ....... <br /> iG <br /> :T <br /> N <br /> O j <br /> vl <br /> a <br /> f <br /> o z <br /> \�d4 <br /> M 0M Vn r Dcoof -0 <br /> op< Cw > > ; <br /> b » <br /> , : O <br /> » <br /> m � C <br /> ,'.o M S <br /> .. ..................jAg#' <br /> ................ ...................................... x A <br /> 4j <br /> Si nature of Owner Date -�" ' pRemarks ... <br /> ................ <br /> /............... .T .: :.. t z :..)Cdr ... .. .. . ..... . . ............................... <br /> ........ <br /> Inspection Date :J/... .. .` ............... � �.............. N a o 'o MM <br /> Zoning inistrator � $ $ $ q <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this applic ition before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans ors ecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS E.'AND APP OVED. <br />