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Burnett Coun'tY ► Office of Zoning Administrator Z. n 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0° " o \. <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 shalt be done In accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. na. f, 0 <br /> _ <br /> OWNwE.t4f�lr„ ........................ . ....................: .. ../.. .....,....................................... 13 <br /> c <br /> N rp r� <br /> " • • CONTRACTOR or SURVEYOR or AGENT m 1.t1 <br /> R (please pr nt) a <br /> I <br /> ...,.... �",�......... ADDRESS <br /> je4s I <br /> eAs-44e lzc................................. .......................................................................................... <br /> + . <br /> ADDRESS S <br /> ADDRESS <br /> `7.1.=5`.-.. . ..6.'..$ s'1................................. ............................................................................................ <br /> PHONE PHONE :c`• :� <br /> . . ............ ........... ......................................... <br /> ............ ....... <br /> .. `. _ <br /> ........................................................................................... .WELL DRILLER <br /> PLUMBER <br /> . ............................................................................I............. <br /> ................................................................... ADDRESS \`n <br /> ADDRESS < <br /> ................................................................................ PHONE <br /> PHONE H <br /> .. ........ <br /> O O <br /> DESCRIPTION 4. Sanitary Facilities: i <br /> v <br /> No. Bathrooms i� o <br /> 'I. Work: �t 2. New Building Details No. Bedrooms ° <br /> New Building ..X... Type of Construction: U, < i <br /> Septic Tank Size Gals. .,........ <br /> Addition ..... ,�: `,�';'.............. 7..�.V. •� <br /> Sanitary ,?C)... Size ..?:.`/...... ft. x .P.. R.40o.. ft, 4a. Absorption Field Site: ' <br /> Filling/Grading Height Stories- . <br /> Area ...../..�,1!.!.fr,... ......... Soil Type .................................... :b o <br /> Moving <br /> Slope ;y <br /> Mobile Home .......... Perc. Rate ................................... J^ <br /> Privy 3. Use (describe exact) , 1 -family Dry Well y _ <br /> Well ,,, home,garage, motel, etc. Seepage Trench <br /> Subdivision .......... .................................I.................. Privy <br /> CampingUnit .......... .................................................... Seepage Bed '�_ <br /> Location of proposed structures and existing structures, well sewage systems, roads, etc., should be sketched in Fig A. Include road ~,.t ,a <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Inter- Z' <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING Z",;!% <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ----------------------- <br /> ------------------------------ ------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x .............. ft. — ............................... sq.ft. <br /> _,.. <br /> �) 4_ <br /> _ N o <br /> o_ <br /> J` <br /> \e n A <br /> n 4. �� s <br /> mss' <br /> 4 : <br /> z <br /> cn r- 'a <' rnmz <br /> ffla a .c a) <br /> rr <br /> s 5fe,� u.t1l �e�rlwce ttte z o "s . a <br /> &L — G( New (� Q : a 3 <br /> ..� e,Q LA, . �� Ln — <br /> s ;U o fr <br /> `'`'�•. ......9...................... ... <br /> Signature f Ow ler Agent Date / i x . • , ; <br /> J( .................... - C <br /> /5....�5....1%t..... .N.P.! !..�?..4 lG(.!n ......rt' :�IFG/ .....<'ti.'V..... � b ...(. : : <br /> Remarks/.......... h.... �" v <br /> e rr `� ............. v <br /> Inspection Date .......................... ............ Zoning AdmirdAtrator a <br /> g g <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 plumhing 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 />