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Burnett CountyOffice of Zoning Administrator u 0 0 <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 described and located as K 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 <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 �l .. ../.. fN <br /> NER (please <br /> riot) CONTRACTOR or SURVEYOR or AGENT <br /> y...9....L>...�. _ <br /> ......./a.:................... ... ............................................................................................ a <br /> ADDRESS ADDRESS .. <br /> b 5. 1 .. ... ..._5-7/f q3... ...ADD........R ..... <br /> ESS............................................................................ <br /> J,..-.. .L _ :. 1 <br /> ADDRESS ,v <br /> ...............6....1..51..a.......................... ............................................................................................ ro <br /> PHONE PHONE s i� <br /> PLUMBER WELL DRILLER <br /> O <br /> ADDRESSADDRESS jo <br /> P..H...O..N..E.. . . . .. . . . . . ............. o- <br /> . r.......................................... ............ ........................ .P.H.O ... ...... ............... ..................... ....... ... ...... hZ <br /> DESCRIPTION Sanitary Facilities: ° <br /> . o <br /> :O <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> New Building .......... Type of Construction: No. Bedrooms .......... c :"�• <br /> Addition ...)5... .............................. no <br /> ...................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... F <br /> Fillingt Grading ....,,,... Height............. Stories ............... 4a. Absorption Field Site: rri <br /> Moving .......... Area ....................................I...... Soil Type .................................... r <br /> Mobile Home Slope .......................................... <br /> Priv Perc. Rate ................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family N <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... u ^� <br /> . .. A/.s[.!�!....................... <br /> Camping Unit ... ...... 11 Privy .......... *' <br /> .................................................... Seepage Bed r <br /> cn <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc., should be sketched in Fig A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter o- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> P <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p -0' <br /> 0 0 <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location:�r-77 ' <br /> .....J B... ft. x .Yly.. ft. . ............................... sq. ft. iNt .............br;0c-F -t��� <br /> ...... ............... ......................... <br /> /n N O <br /> o � <br /> � w <br /> � r O ••ice <br /> 0 <br /> 0 <br /> v 7 <br /> 'See V G'rl'i re o <br /> .o <br /> �i <br /> n Q W < m c m <br /> o „ � . om <br /> 'k O <br /> •-,� vii -� � — <br /> Q o -i <br /> M <br /> . ..... .. ........ o C_ <br /> Signature of Owner or Agent � Date <br /> X <br /> Remarks ............................ ............................................................................................................................................ mm <br /> m I <br /> II <br /> ............................................................................................................ .... ............... ................................................. O <br /> Inspection Date ....................................... ...................... ? tl o 8 m <br /> ..... ....... . .. ............ . <br /> Zoni Administrator 8 8 8 8 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facili s <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attache to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any bu lid <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 inlstrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />