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v - <br /> Burnett County Office of Zoning Administrator Z' o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H :� <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 <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a / <br /> OWNER (please print) (c)O��J . /f�Y CONTRACTOR or SURVEYOR or AGENT a M <br /> l0�/5��utC/NbHA>NC'r, . ............................................................................................ E <br /> ADDR SS ADDRESS <br /> !v$/gsTl�/ey...w/ SCi <br /> ........................... <br /> ADDRESS ADDRESS <br /> .. ...................... . . . . .................................................................................... <br /> PHONE <br /> PHONE. ............................................................................... <br /> PLUMBER WELL DRILLER <br /> O <br /> ADDRESS ADDRESS o �It\ <br /> ............... . ... . . . . . .................................... ................. ............................................................................................ o <br /> PHONE PHONE Z :� <br /> DESCRIPTION 4. Sanitary Facilities: ° o o <br /> 1. Work: No. Bathrooms '� •� <br /> 2. New Building Details •""""' >'• <br /> New Building �! No. Bedrooms .......... 'oo <br /> .../.... Type of Construction: <br /> Septic Tank Size Gals. ....... : <br /> Addition .......... ....... ........... ....................�...p .... <br /> Sanitary .......... Size ...... . .. ft. x ....9��..T......ft. .......... <br /> ....... Height .... . 7Ctorie �....... 4a. Absorption Field Site: <br /> Filling/Grading ... <br /> Moving .......... Area ........ Z Soil Type .................................... '• .o <br /> Mobile Home .......... Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... ca <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision �"W'. � Seepage Trench .......... .� <br /> .......... ......... .......................................... <br /> Camping Unit Privy .......... k1 <br /> Seepage Bed .......... w <br /> ----------------------------------------------------------------- <br /> W n <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- 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. o <br /> _-- V <br /> 5. Lot Std/ ( Fig. A. 6. Lofia ion: <br /> l7 �C... ...!y.....Sr3rVl�... <br /> .. .. ft. x ... ...... . ft. — ............................... sq.ft. <br /> 3 <br /> N 'XO <br /> O o <br /> c itf <br /> o <br /> IV z <br /> w <br /> N <br /> I � r M o a : mZ <br /> M E,c, 0 m E. F <br /> c = a <br /> ` Z Oo' M n gIng M <br /> o a 3 <br /> ery, X� , A m <br /> A <br /> Ig a re of 0 ner o ent—}� Date �/. (1 I I X <br /> R marks .....( .:.' . . . ... `..'... ....... .,... !,`.: .....Ql..b.�M..:..........`..!A'.l.l.�ruw...lt�r-............. � � v <br /> e r,tom, deo �w4 ra` COIL"(I/ d ' <br /> .......�°,r..asks.................s�..,/...r................. . ..............�............................................................................ <br /> iay II <br /> ... . ..................................................... U/ <br /> :. o. A m <br /> Inspection Date \ ro <br /> ...................................... v�,,, <br /> Zonin Administrator $ 8 8 8 g y <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 />