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Burnett County Office of Zoning Administrator vq 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 2' 3 d <br /> d <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as 0µ J <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. I <br /> 3 <br /> k <br /> Lt%�r C h,r.^.:...L.t`..tC�?�c:'. . ..........................f rur�erJ - d <br /> .. <br /> . . <br /> .......... . <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> ........................................ .A <br /> ADDRESS ADDRESS .* NILpry <br /> y <br /> i� <br /> . . .............................................................................. .A.......................................................................................... <br /> ^ti <br /> ADDRESS DDRESS <br /> ........................................................................................... . ... .................................................................................. I <br /> PHONE PHONE.... .. <br /> ........................................................................................... . .WEL. .. . <br /> L.DRI.LLE. . ..R.................................................................... <br /> PLUMBER <br /> i <br /> ADDRESS ADDRESS m <br /> n o :1: <br /> ........................................................................................... . ................................................................................... o 7; <br /> PHONE PHONE H <br /> Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> New Building „••••,,,, Type of Construction: No. Bedrooms .......... <br /> AdditionSeptic Tank Size Gals. ...... Oai <br /> .................. <br /> Sanitary .......... Size .............. ft. x ft. .......... t F <br /> FillinglGrading .....,.... Height............. Stories ............... 4a. Absorption Field Site: i i i Wir <br /> Moving .......... Area Soil Type .................................... r <br /> Mobile Home .......... Slope .......................................... V: <br /> Privy „•....... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> .......... Evtc; <br /> Well ,,........ home,garage, motel, etc.) Dry Well <br /> SubdivisionSeepage Trench <br /> .. .... .......... <br /> Camping Unit .......... N' <br /> .......... .......... <br /> SeepageBed ..........---------------------------------------------------------------------- <br /> e <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road o <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter <br /> or <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 /> 0 <br /> 5. Lot Size: Fig. A. 6. Location: l <br /> ................ ft. x .............. ft. — ............................... sq.ft. an <br /> ' c E <br /> e <br /> 0 <br /> p o . <br /> io1-5 <br /> n <br /> p�n <br /> 0 <br /> � fin <br /> o <br /> 0 <br /> d <br /> r m <br /> 1 <br /> r m a, Z <br /> ;E <br /> m <br /> C c N a � <br /> a — m <br /> Z oo ynm <br /> n � � <br /> . . . . . .................... o c <br /> ignature of O.w.ner or Ag t Date — <br /> x 70 <br /> Remarks ......................................................................................................................................................................... U,t p <br /> .................................................................. ...... ........................................................................ : <br /> d7�-✓_I fin.o ^' T <br /> Inspection Date ....................................... .................................�. ?"'? Q............. ..:...�..2. �..................... o o u o � o v, m <br /> Zoning Administrator ✓ ( 8 8 8 8 8 8 W <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, it 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 InforrnatiOn 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 />