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Burnett County. Office of Zoning Administrator C 0 0 <br /> APPLICATION FOR 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 <br /> shown here'n. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a N <br /> -Z....... ........... . .......................................................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a YI \ <br /> !.y` ........�afy.�.. .:.t#.!> �...... ..................... . .......................................................................................... „VVV <br /> ADDRESS ADDRESS <br /> sTPater 1A AIS s s' fya <br /> ............................................................................ . ......................................................................................... :n <br /> ADDRESS AD.. DRESS <br /> ...... ........ ........ .................................................................. . ....................................................................................... :\ l <br /> PHONE PHO.... NE <br /> Cru... ..... ,r..... a�,�so.� .........:y.v.%.a....... . .......................................................................................... x <br /> 'yy <br /> PLUMBEFI ;--r— WELL DRILLER �� .G\ 0 °� <br /> .�7�.�.�r.......s. ................................... <br /> ADDRESS . ............................................................................ <br /> ADDRESS <br /> c V / < <br /> PHONE 71 S" t• 3 S a- V P' 7 PHONE Z r :Ivsl <br /> DESCRIPTION 4. Sanitary Facilities: o ° 1' <br /> Bathrooms <br /> 1. Work: ( / 2. New Building Details No. <br /> No. Bedrooms o ' <br /> New Building .....,.,,, Type of Construction: <br /> 7 <br /> Septic Tank Size Gals. . .>.. <br /> .� <br /> Addition .......... ....... ............................................ Sep ,C <br /> Sanitary ,dam. Size ....... .. ft. x " """ <br /> .o. <br /> Filling/Grading .......... Height............. Stories ..... ......... 4a. Absorption Field Site: ; <br /> Moving .......... Area .......................................... Soil Type .................................... r <br /> Mobile Home Slope ........�.. ..a................... ". <br /> O <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .... ..................... <br /> Well .......... home,garage, motel, etc. Dry Well .......... --�- <br /> Subdivision Seepage Trench .... ( i <br /> CampingUnit .......... ...................-............................... Privy <br /> Seepage Bed .— <br /> _ocation 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 l! O- C <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING I < u <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ^ O <br /> ---------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: - <br /> ../..Q..U�.. ft. x . a..v.. ft. — ............................... sq. ft. ............................................................................... i <br /> r <br /> 1 � m <br /> N G O <br /> O qJ <br /> � XV <br /> O <br /> W � S <br /> : I O <br /> T <br /> jee "*oe o z <br /> d <br /> [E <br /> M N r 9 N m Z <br /> m Na C — d to <br /> o m < <br /> m <br /> z m <br /> Z o o n � �7 <br /> O O n m 3 <br /> ignature Owner or Agent Date <br /> X <br /> / G..'. O <br /> Remarks ... .. .. ...Lr `LJ-'P�"_-'...................................................................................................................... <br /> P <br /> II <br /> Inspection Date '2 <br /> ` -: d...... .^.f... <br /> .... ....... ............ <br /> . . ol.. .... J.......... ..Z.... . . <br /> G .. W <br /> O N O N O N <br /> i i 8 8 8 8 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa�l hies <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 riot 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 />