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Burnett County Office of Zoning Administrator iv 1 -1 z <br /> o <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 describedand located as 0 °{ <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 <br /> Ordinance, Sanitation Cade, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0_ i <br /> F.......STf..� <br /> . .S.f... .. . . .. ............... ..... .............. ....... ............!�-...........NT .......................... <br /> OWNER (Please print) �. CONTRACTOR or SURVEYOR or AGENT <br /> m ; <br /> 2.7.. !..f.. ...... . ....... r�LrC�.p..........?.7.43`i �� PSI Com.-weII LIT d <br /> ADORES ADDRESS ' ........................................................ . m <br /> . 5+ �....... . .. Z............5.`1. ..�13.... ........... tie.bsevZ...............wT........5.`.I.aF� <br /> ADDRESS ADDRESS <br /> -7.i 5..-...Q( E':. ��.C Z ...... ?.�C?.. �'.......................................... <br /> .. . ....... ................................... <br /> PHovE X <br /> C PHONE � pg <br /> .........w.'"f1.7 F i �- <br /> 1........................................................................... ..... ............1>,� � tv.�.................................................... E [ ETrI <br /> PLUMBER WELL DRILLER <br /> ADDRESS .ADD.......R..ESS.......................................................... <br /> .... <br /> ........... <br /> ........ <br /> n O k...� <br /> G7 :� <br /> < :: <br /> PHONE PHONE i <br /> DESCRIPTION4. Sanitary Facilities: ° o 0 <br /> 1. Work: )eLr 2. New Building Details No. Bathrooms 'O <br /> 0 <br /> New Building .......... Type, f Co struction: No. Bedrooms ........., z <br /> Addition .......... ;-...... „c-k,,.................�.......... .. Septic Tank Size Gals. ......... S <br /> Sanitary Size .......�..E:. ft. ...... ft. .......... <br /> FininglGrading „ .,,,,,,. Height.....:. Stories ...... 4a. Absorption Field Site: <br /> MovingSoil Type ...... ............................. <br /> ........................................... r <br /> C i o <br /> Mobile Home ......... Slope ................................1......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... i <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision .......... Seepage Trench .......... <br /> .................................................... <br /> Camping Unit .......... Privy O . <br /> .......... <br /> .................................................... <br /> Seepage Bed <br /> ---- --- — -- — — <br /> -- ---- ------------- -- <br /> -- — — ---------- <br /> Oe <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched in Fig- A- Include road W <br /> Q <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 <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING p <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ----__.---_ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. O <br /> C <br /> N <br /> n <br /> N O <br /> o = <br /> �STe s (in <br /> tT o l/' <br /> 0 <br /> _ <br /> s <br /> � <br /> T <br /> �t z c. <br /> 0 <br /> st <br /> S � <br /> t� q1 to u�4 U 4l rw __j <br /> to Z <br /> lb <br /> rp N d D. .c d 4 ffl <br /> m <br /> 0ng0 a a <br /> a <br /> ........................ <br /> . ........... .. <br /> Signature of Owner or Agent i _ Date ° p <br /> Remarks ........ . .... O....._”. ... ...4 �t-......... .. .L.t7.... ...... '�.�..b.::\...... .!.. .v.....L.LW..................... X m <br /> ?. <br /> T :€.. ... ... ..... .u.. 1......N.rz ......!�T........... .. ..... !.b.1. ..! a4.y........ uZD u �................. <br /> .o. .s. ................................................................................................................................................. <br /> InspectionDate ....................................... ................................................................................. o u `r o �(oir�n m <br /> �offl) m <br /> Zoning Administrator 0 0 0 0 0 to <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 he made Without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />