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Burnett County Office of Zoning Administrator d ✓ 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 w <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 is <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a :� <br /> "' n O• O <br /> C.��..9�.�. . �........5.< .. ..4..n..�°..Nn.a..� ...... ................ - r <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> .6...aV7...r.'......,C.e.7...t....T''..�1!L................................ ............................................................................................ a <br /> A D D R E� ADDRESS .* <br /> . ... ........hn...n.......�r5a� ................... . . ...... . ............................................................................... q� S <br /> ADDRESS L ADDRESS <br /> PHP........................... ............. .PHONE................................................................................ �J\ <br /> ............. .... .......................... <br /> ... . .. . ....................................................................... 1 7 <br /> PLER WELL DRILLER <br /> ........................................................................................... 'A'DI...................................................................................... <br /> ADDRESS ADDRESS ?� <br /> n O <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° { <br /> 1. Work: 2. New Building Details No. Bathrooms o J <br /> New BuildingNo. Bedrooms °� a <br /> .......... Type of Construction: m <br /> Addition .,.... Septic Tank Size Gals. .......... <br /> r < y <br /> Sanitary „X Size .............. ft. x .............. ft. <br /> FillinglGrading ......--\\.. Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... i o <br /> Mobile Home Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well home,garage, motel, etc.) Dry Well .......... .� <br /> subdivisionSeepage Trench .......... <br /> .................................................... <br /> Camping Unit .......... Privy ..... <br /> ...................................I................ ry <br /> ------- ------ — — — --- — — <br /> -- --- -- ------ -- Seepage Bed------- --- C-1 <br /> Location of proposed structures and existing structures, wall, 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- A a <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. <br /> o <br /> .__ -------------------------__---------__------------__—__--------------- ^ <br /> h <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — sq.ft. ............................................................................... <br /> iU <br /> be <br /> n <br /> N < O <br /> ' O O <br /> 1r 3 <br /> V ~ V <br /> 4 O <br /> I t � <br /> frame z <br /> o � <br /> 8 <br /> 7J � Nr v .Nmz` <br /> -if <br /> k m '9 <br /> T <br /> o)�� am <br /> o m <br /> Signatu e of Owner o Agent Date <br /> - X : . X <br /> Remarks .0.k .�...?�E' `...................................................................................................................................... <br /> ea <br /> ............?i�IC. 1 �f.. c� �. �� T.c �� .................................................................. <br /> ............................................................................................................ <br /> Inspection Date .............. ��l:Lll.�!... .. .Z- -.- <br /> ........... U N N N m <br /> Zoni Administrator � 0 0 0 o p) <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa4:ilitins <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 lige <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of the Zoning Adminlstratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />