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e—/ it-') (' I" , e . (• , <br /> Burnett County Office of Zoning Administrator to <br /> M o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < H o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c i ?�k <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 ma rW <br /> �ON <br /> `s LP'R Iplease pr tl CONTRACTOR or SURVEYOR or AGENT o. <br /> •�L � ... ....... .?.l y.i .I..P...l�..E..../Q.1!� M �avFA PvL1s ................................................1 <br /> .... ... ......................................�. m <br /> ADDRESS ADDRESS <br /> ............ O <br /> 0 <br /> ADDRESS ADDRESS <br /> PHONE.......................................... ..................................... .PHO..................................................................................... '� <br /> C............... .......... ............ ....... ..... ...... ...... ..........C. <br /> . .......... . <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS m <br /> n 0 O <br /> o <br /> _. <br /> .............................................................................. ..... ..................................................................................... <br /> PHONE PHO..NE Z � � <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••• <br /> New euilding .3 <br /> ✓ Type o Construction: No. Bedrooms . .. 1 <br /> Addition ,,,,,,,,,, ,,,,,fR F Septic Tank Size Gals. .......... <br /> ............ ............................... r < <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stor' s ...;... 4a. Absorption Field Site: <br /> .. . / �i...G/.t�".. Soil Type .................................... � ` •r <br /> Moving Area .l.N..CLG.... a p <br /> Mobile Home .......... Slope .......................................... <br /> Privy ........ . 3. Use (describe exactly, 1 -family Perc. Rate ................................... .. <br /> Well ,. home, arage, motel a)c.l Dry Well .......... <br /> Subdivision-- Seepage Trench .......... <br /> Camping Unit G4 .... .................... Privy .......... <br /> ��""..."'. Seepage Bed <br /> ------------------------------------------------------------ r <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road Jl i on M <br /> setback, side and back yard dimension and location and setback from all bodies of water. If <br /> property is located at a highway mien- <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. UKo <br /> ---------------------------------- ---------------------------------- �l <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> m <br /> N O. <br /> o � <br /> c <br /> O <br /> S <br /> 0 <br /> C <br /> z <br /> 0 <br /> m <br /> 7a Nr�v � mm � <br /> c m c m <br /> r,o C ? E <br /> °. N < \ m P <br /> O n a <br /> 01 C) <br /> �.o z <br /> . � . ..... ..7:. P-.. y..... : C <br /> Si nature of Owner or Agent Date o C <br /> Remarks S44 m <br /> m <br /> va <br /> .. ................................................................................................. . . . <br /> ^. , N8W - Nm <br /> InspectionDate ....................................... �2?Tom. ....-...... ................. .. . . ... . ............. . . . . . N m <br /> Zoning Admin strator : 8 8 S S S 8 ti <br /> NOTE: A preliminary site Inspection must be made and site approval granted on ell structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must he 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 Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />