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Burnett County Office of Zoning Administr for <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT 3. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and IF 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the m i <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulationsof the Stateof Wisconsin. <br /> .� /_ <br /> .... ..w. /•L7:....�.�f�.�1........L/.�iN...7��...................... ............................... / ..N`,.V T .............. �' A � <br /> OWNER (plans print) CONTRACTOR or SURVEYOR or A.NT f' Y3 s <br /> 35. ..0..... U0N1...... ...................................... <br /> ADDRESS ADDRESS <br /> &v.P�.y.......... ......... .... .................................................................................... ....... t <br /> ADDRESS ADDRESS <br /> . <br /> ...6 �. .. .. %. <br /> E ... ar................................................ .................................................................................... ....... q_n <br /> PHO00 <br /> NE PHONE <br /> ........................................................................................... 'W"'E' ...L...D.RIL.. L......ER............................................................... ....... <br /> PLUMBER WEL <br /> ADDRESS ADDRESS C <br /> ........................................................................................... ............................................................................................ O r <br /> 1T <br /> PHONE PHONE Z N r f'/ <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° ?0 <br /> 1. Work: r 2. New Building Details No. Bathrooms ..... o i� <br /> New Building �L T No. Bedrooms <br /> . ...... Type of struction: ' ....... <br /> Addition Septic Tank Size Gals. .......... <br /> .......... ........... ...../L.................. ......L`........ <br /> Sanitary .......... Size .. .Q•. ft. x ... ..F? ft. . ........ . <br /> Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: <br /> Soil Type .....................MovinG ...... ........ <br /> .......... ........................................... i r i <br /> C <br /> Mobile Home Slope ................................. ........ .. <br /> .......... <br /> m <br /> Privy 3. Use ides exactly,'1 -family Perc. Rate .......................... ........ <br /> Well .......... home garage otel, etc.) Dry Well ..... T <br /> SuDdlvlalon .......... Seepage Trench ..... o o^ <br /> r <br /> Camping Unit .......... .................................................... Privy ..... ..� ;•_ <br /> Seepage Bed ...... ;c, . <br /> gn <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at <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. — B �o <br /> ------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> lJ" <br /> 6 S6 <br /> o <br /> A <br /> o IV' :W <br /> vl <br /> f' 1 <br /> 0 <br /> M 0 <br /> o ,z <br /> _ M N V W r D to W <br /> n V P `^ _ <br /> O< d C y <br /> pJ 3 <br /> ip ep <br /> wO : D <br /> on : <br /> M <br /> M <br /> ... .... .I..:.�.... . .......................... ...................................... O A 0 <br /> C <br /> a <br /> j <br /> i atureOwner ent DateRemarks <br /> N <br /> .......................................................................................................... .. ................ . ..................... <br /> Inspection Data N O] N + N T <br /> Zoning dministrator � 8 118 <br /> 8 8 8 <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 aseptic 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 AF PROVED. <br />