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Burnett County Office of Zoning Administrator �' c <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m ^' <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and - <br /> regulationsoftheStateofWisconsin. <br /> ........................................................................................... ............................................................................................ <br /> OWNER IDleax prin 1 ' CONTRACTOR or SURVEYOR or AGENT A i <br /> - <br /> .. .. ... ... .... .. .. ... ....................... . ..................................................................... .................... a . <br /> .................. ... ............................................................ ADDRESS <br /> ADORESSl.1..�.....1:.1../.........'R. S� ... .ADDRESS..... .. ................ .............................. .................... � :--- <br /> - <br /> PHONE /��` yy PHONE <br /> ..................... <br /> ........ ................................... . ............................................... <br /> PLUMBER WELL DRILLER <br /> ADDRESS 'A"DD'R"'E'S"S'... .............. .......... ........... ............................... :-- <br /> A0 <br /> o O — <br /> ........................................................................................... .PHON.. ..E. .. ................................................................................... .r <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building .., No. Bedrooms O <br /> ... Type of Construction: <br /> Addition ,` Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .../6.�.... ft. x .. ...a� ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... <br /> Mobile Home Slope .......................................... D <br /> Privy .......... 3. Use (describe exactly, 1 .family Perc. Rate ................................... <br /> Well ,,,,,,,,,, home,garage,motel, etc,.) Dry Well .......... 2 <br /> Subdivlalon .......... ...Ef.A *.hf.�/.�:q..... .457iF-.... Seepage Trench .......... o E -LIZ' <br /> Camping Unit .......... Privy .......... .C. <br /> .................................................... Seepage Bed <br /> ..... <br /> -------------- — <br /> , <br /> En <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched ins c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at : ,�i F <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. _ o' <br /> -------------------------------------- ----- ---- <br /> 5. Lot Size: �22 1- 6. Location' QJ �')�',•�••��c•�� <br /> /(.f..Q.... ft. xV.. ."l.. ft. - ............................. <br /> .. s ........... ... ...�.�f..— .4.?.:'... <br /> L-kK =i C �,,,� o <br /> �` , <br /> :tea <br /> LL3( <br /> D <br /> O <br /> IV <br /> Lpa < > >o c c m <br /> mac : n <br /> cay <br /> 1 y1I 9 C�. . N o N > > 3 <br /> o rn o O •2 D - -f <br /> Q » <br /> � O : 0 <br /> �0 <br /> .:...1-..� `fix n : M <br /> m <br /> Signat a of Owner or Ag nt DateRemarks <br /> o ; <br /> T n ' <br /> m •• <br /> O ' O <br /> Inspection Date � ^' m ^' � �' m <br /> Pe � -1 4 ��C/L mNmooa <br /> Zoning Administrator' x� r <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />