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r <br /> Burnett County Office of Zoning Administrator v o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 'JZ' <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use A C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 aim <br /> M...�'.R..7"....... Ism --dam �� � -n <br /> .. . ............................ . .............. ... . ...................................I.................... <br /> : F <br /> OWNER ( lease print, %� CONTRACTOR or SURVEYOR or AGENT o. <br /> AS ................................................ .ADDRESS............................................................................ <br /> ..... <br /> ............................................................. <br /> ADDRESS ADDRESS............................................................................ \�I <br /> x...92...-...... ......'.. ...... .... . <br /> PHONEPHONE <br /> ................................................................................ <br /> ........... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS <br /> n o <br /> PHONE PHONE <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building De ails No. Bathrooms i <br /> �f .......... <br /> New Building ...(\... TypR qft nstru tion: No. Bedrooms .......... �i 'Oo <br /> C (/ o: <br /> Addition ...... ... Septic Tank Size Gals. .......... I <br /> Sanitary .......... Size �.. ..... ft. x ft. <br /> . . ... <br /> FiIIingiGrading .....,,,,, Height.j.F Stories ............... 4a. Absorption Field Site: } E <br /> Moving .......... Area ........................................... Soil Type .................................... ` r r <br /> o <br /> Mobile Home .......... Slope .......................................... .. ; <br /> Privy Fare. Rate ................................... ' <br /> 3. Use (describe exactly, 1 -family � <br /> Well home rag , motel, etc.) Dry Well .......... ril <br /> Subdivision Seepage Trench .......... <br /> ,,,,,,,,,, <br /> r <br /> Camping Unit „ ,,,,,,,, Privy .......... N <br /> ................................................... Seepage Bed <br /> .......... ya <br /> ------------------------------------------------------ ' N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc, should he sketched In Fig- A- Include road S <br /> setback, side and back <br /> yard dimension and location and setback from all bodies of water- if property Is located at a highway inter- h 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 /> N O <br /> ---------------------------------------------------- <br /> �.. 19.3-0. <br /> 0 _ <br /> 5. of Size. U Fig. A. 6. Location: <br /> �.�. ... ft. 19.3....... ft. . ............................... sq. ft. ............................................................................... <br /> P <br /> a <br /> n <br /> N o <br /> L � K � <br /> 0 I <br /> \ ^ � <br /> T :�r <br /> z :O` <br /> O <br /> _ <br /> 77 N r v m o0 <br /> N _. Cp W <br /> o an <br /> (fin a .ca <br /> mI <br /> ... ........ ........ . F 'Y”(/Iy/�..!� ... — <br /> Signatur f Owner or Agent Date <br /> O ° C <br /> X <br /> Remarks ......................................................................................................................................................................... T m <br /> v <br /> ............................................................................................................................................................................. <br /> ........................................................................................................ <br /> :try N -n <br /> Inspection Date ....................................... Q!!1,o../ ...7............. ...... . . .... G o 8 m <br /> . . <br /> Zoning A inistrator �d 8 8 8 8 8 8 ym <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 it 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 />