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Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITF <br /> d � o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < a µ :,' <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 <br /> with all other applicable County Ordinances and the laws <br /> and regulations of the State ofWisconsin. 3 a \il <br /> ............................ �..l.G: /.* ..........V1 <br /> �. .I' ........................................ Jo <br /> OWN (please print) COI�fTRACTOR or SURVE�R or AGENT a N' <br /> ...0...................................................................... <br /> ADDRESS ADDRESS .+ <br /> / — <br /> ..... . ... ............................................................................... `•C./L-(1=c.K:: Gly/ �Y.:2................................... _ <br /> ADDRESS ADDRESS <br /> :O <br /> ................ i \ <br /> PHONE PHONE <br /> ........................................................................................... . . . ..................................................................................... <br /> PLUMBER WELL DRILLER <br /> O <br /> ADDRESS ADDRESS <br /> n O <br /> ........................................................................................... . . . . .................................................................................... <br /> PHONE PHONE Z n '•i� <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° n <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••••••••• of C- <br /> New Building •,,,,,•,•• Type of Construction: No. Bedrooms .......... '. a <br /> AdditionSeptic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading „ ,•,,,••• Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area Soil Type .................................... r <br /> Mobile Home .......... Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision 41l.. Seepage Trench ...I...... <br /> .................................................... <br /> Camping Unit ,,,,,,_,,, Privy .......... <br /> .................................................... Seepage Bed <br /> .......... <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig A. Include road Q <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 /> ---------------------------------------------------------------------- o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> q 336 3' 37 Lam = � 0 °_ <br /> 0 <br /> J ' Z <br /> o � <br /> Ate— - nSee m,ti�les o� Dem arra, 14&5 Iots mei ^a • -�- U }v ' <br /> s..p ( �'ew �Or app rC..<_.t o� ,1+3 f <br /> iU(. [ r (a <br /> fj- <br /> wed mn� Aef” be U -d uses. <br /> nQ'� m <br /> onc m <br /> 5 <br /> a ry d D) <br /> (T < C ,pro C m <br /> D <br /> iA o <br /> a m <br /> o c'. o. <br /> m <br /> a <br /> ...................................... s <br /> Signature of Owner or Agent Date C <br /> X <br /> Remarks ......................................................................................................................................................................... <br /> v <br /> ........................................................................................................................................................................................ — <br /> .............................................................................................................. ............� j « T <br /> o;p N N d N m <br /> Inspection Date ....................................... �r.�..'...—......... u. u, o v, o v, <br /> ... ... . ........9... <br /> r% Zonin Adminis for : " 8 8 8 8 8 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f d C I I it ius <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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> 3, �t/.1' ' Lr rZ27V5-h <br />