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Burnett County Office of Zoning Administrator L' - o o <br /> APPLICATION 1cOR SANITARY — LAND USE — BUILDING PERMIT �. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a ;V <br /> ................................... . ........ <br /> AGENT <br /> OWNER print) CONTRALTOR..orSU.R.V.E.Y..O.R..o.r............... ..... . . .... . <br /> •i�i1�., <br /> ..... .�.1.........(................................................................... . .......................................................................................... <br /> ADDRESS ADDRESS <br /> I[G � ............................................................................ <br /> hk:..................! ... ...........:...................�......�............. <br /> ADDRESS f ADDRESS �. <br /> ........................................................................................... ............................................................................................ <br /> PHONE �� PHONE <br /> k S} �.�riP f-L`�c' <br /> ..1.�:...�.. ................. .. .�::................:........................... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> ..... :.. .. ..> E .................................................. 'AD'D'RESS'­­* <br /> .... . ....... ........................................................... . <br /> . ............... <br /> . <br /> ADDRESS ADDRESS. . . '� � .O v <br /> 5 �I <br /> 1..��. :. .. ....... ......................................... ....................... `. <br /> PHONE PHONEV'- <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building ..,�.... Type of C,o structipn: No. Bedrooms .. <br /> �.. rit C- Septic Tank Size Gals. = E <br /> Addition .......... ........ ........................................... '• ?+� � <br /> Sanitary �(..... Size .............. ft. x .............. ft. .......... <br /> Field S <br /> Fi <br /> ti <br /> Absorpon ei ; 3 <br /> Filling .......... Height............. Stories ............... 4a. : : : `• <br /> Moving Area Soil Type ........ ................... o i <br /> ......................................... <br /> Grading Slope .............. 5....... ,..... in. <br /> .......... <br /> Mobile Home .......... 3. Use (describe exac y 1 -famil' Pere. Rate .......... <br /> /' a nni l .:...... ......... <br /> Privy ... ... home,garage, motel`8t Dry Well <br /> Well '„• Seepage Trench .......... i <br /> ..... . .............. ..................................... i <br /> SubdivisionPrivy <br /> .......... .................................................... <br /> Seepage Bed .... <br /> ------------------------ --- ----------------- iCt cn t`!, <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- CL <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> } y A <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -------------- ------------ -------------------------------- '(ti <br /> 5. Lot Size: cS -------Fig. A. t <br /> ................ ft. x .............. ft. — sq.ft. - <br /> ! Cn <br /> m <br /> N o. <br /> 0 <br /> 0 <br /> .rN <br /> T i G <br /> .4 Z <br /> :1 <br /> � cnrvgcnm” <br /> ru = d �.�odc <br /> n y3 tT � c - ?.-• .9 <br /> -0 to <br /> < C: m <br /> Z a ° : 3 <br /> O <br /> Signature of Owner or'beo Date x m <br /> Remarks ............................................................................................................................................................................ m p <br /> ........................................................................................................................................................................................... <br /> : . <br /> ......................................................................................................................................................................I.................... <br /> !/'� ......................... ` i o cn o m <br /> Inspection Date ....................................... o.o o m <br /> Zoning Administrato. 0 0 o fA <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 he 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 />