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13wnetd County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> o .� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '_ s' v <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 i <br /> m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n <br /> � O <br /> . .Y.l•.G'.. N!7..k.'L ......... .�....�M. .. -�'. SRA <br /> .r..........O...................... <br /> CONT .................................................. <br /> OWNER (ease print) CTR or SURVEYOR or AGENT <br /> ADDRESS' 1 %' `t ADDRESS iv <br /> ........... /5 ............ S � oZ � <br /> ............................ � <br /> ADDRESS ADDRESS <br /> Cl:�e <br /> PHO ...... .................................................................... .PHONE.............................. ............................................ <br /> ........................................................... .. <br /> ...................... <br /> a...l� .. .............................................. �........ <br /> PLUMBER � WELL DRILLER � , it i'tJ <br /> �.... �.a.. o <br /> ADDRESS ADDRESS n o <br /> . .............................................../...... .................................. <br /> ................................................................... v) <br /> PHONE PHONE Z � r <br /> DESCRIPTION 4. Sanitary Facilities: / ° o ° <br /> Bathrooms <br /> 1. Work: 2. New Building Details No. vl�. , <br /> Type of Construc��gn; <br /> Addition ...... <br /> New Building No. Bedrooms �:r. <br /> ,,,,..,,,, """ <br /> yys [ y Septic Tank Size Gals. .......... <br /> .. ............. a ............. <br /> Sanitary Size .............. ft. x .............. ft. <br /> " <br /> ' ' 4a. Absorption Field Site: <br /> Filling/Grading .......... Height............. Stories ............... <br /> Soil Type .................................... :/�, r <br /> Moving .......... Area ................................... O <br /> Mobile Home Slope .......................................... :�i <br /> .......... <br /> Privy .......... 3. Use (describe exact) 1 -family <br /> Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc. Dry Well .......... „^ a <br /> SubdivisionSeepage Trench .......... F�' <br /> Camping Unit .......... .................................................... Privy :I <br /> Seepage Bed <br /> ! ' do <br /> - <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc-, should he sketched in Fig A. Include road 'eR :moi Q o� <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING e� <br /> P <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. R` o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> A <br /> n <br /> 0 <br /> N Q O <br /> o <br /> V <br /> O <br /> 7 _? <br /> h a <br /> Z <br /> 0 <br /> oW �uf�a <br /> 7,7 fnr 11 :E.ym Z <br /> — d nm <br /> 'OtT < C ,� m c <br /> oT. <br /> o 0 Da <br /> M <br /> Z <br /> n 70 <br /> _. ° ° ato <br /> n m 3 <br /> Cc 7p�Jj / �rZ $3� D c <br /> Sig at of Own nr or nt ate j X <br /> Remarks ..... ..1 ... .1(.... r:.fr. .:..f`7...................................................................................................................... 0 <br /> m <br /> ise <br /> ......................... .. ................................................................................................................................................ <br /> 11 r <br /> .................. 1� 1r.-°«G.z:>z.. '.... `L� .: � .................................. o; <br /> r' �' m <br /> / — Z X 7 .....i.., r`� �n rn o iii 'o rn m <br /> . . .. . .... . <br /> InspectionDate ...........1...:............ ......... ... ... — ........`............................. . <br /> Zoning Administrator 888 J 8 VJ <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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />