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Burnett County Office of Zoning Administrator d M 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT R. 3 <br /> o SJ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '- <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 V <br /> - d O <br /> 3.C. . ......... .l .4.1. ......................................... ............................................................................................ <br /> n <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT m i m <br /> �.s.A......�T.... l.......... .. a : <br /> . . . .....................................................................................ADDRESS <br /> ADDRESS <br /> ...nLtj <br /> AT <br /> ADDRESS ADDRESS <br /> qqpp 11 . . . ...................................................................................... '\ <br /> ..D..�.SS ..1�..�3RO........................... ................. ' <br /> PHONEPHONE <br /> ................................... . .. . . . . <br /> PLUMBER WELL DRILLER i <br /> P.o...fox.. ..i........5.PoQua2 �............. ............................................................................................ <br /> ADDRESS ADDRESS O <br /> ......................................................... ............................................................................................ <br /> PHONE PHONE <br /> DESCRIPTION o H <br /> 4. Sanitary Facilities: � o <br /> 1. Work: .,/ 2. New Building Details No. Bathrooms ... .... . <br /> No. Bedrooms ° <br /> New Building /� Ty�?e, of Construction: �•�•�•• ^� o <br /> Addition „e �„FRAME Septic Tank Size Gals. ........ . 3 p < <br /> .......... r�.+f .... <br /> Sanitary .. .... Size .A';NG.... ft. x ....�.7..1�/...ft. .......... a: <br /> (( t 4a. Absor tion Field Site: f� i <br /> Filling/Grading ,,,,,,,,,, Height. .. ...., $tOr• s ..)../.�,.... p is <br /> Moving .......... Area ... ,,..f'.. .Q.fJ....... .... Soil Type .................................... m <br /> Mobile Home Slope ° <br /> Privy3. Use (describe exactly, 1 -family <br /> Pere. Rate ................................... L i <br /> Well Dry Well ......... <br /> . home,garage, motel, etc.) <br /> Subdivision Seepage Trench ........., <br /> Camping Unit ......,,,, Privy .......... V1 <br /> .................................................. r <br /> Seepage Bed ......... , <br /> —————————————————————————————————————————————————————————————————————— 0 •m <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 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING I <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o o <br /> ----------------- <br /> 5. Lot Size: ^ Fig. A. 6. Location: ?� <br /> ...�.QQ..... ft. x ...�.,/.1L7 ft. — ............................... sq. ft. ............................................................................... <br /> p <br /> / b <br /> LAkL too N O <br /> O � O <br /> 3 <br /> 3 :\ <br /> � W <br /> ! O <br /> F <br /> 85 <br /> 1 'O <br /> z <br /> 4(,o af� <br /> 24 <br /> 7 � � <br /> M T� <br /> �7 N r boy CUP <br /> O aE <br /> m � . f <br /> .. N.on < -.0 m <br /> Z 0 n <br /> 9 to' o a <br /> wo <br /> �. <br /> p <br /> ... .................. 0- <br /> Signature of Owner or Agent Date �qJ _ <br /> Remarks4--d <br /> dt-/. m <br /> . . ........ . X <br /> ............�c� 6� o <br /> 11,..........i�/L ..........'b....... .... P..... �f .. Ate... qn, s r7`o�. C� •y 4 EW al <br /> ........ .. ...... g <br /> y� .. <br /> 'f- 1441' .�j.,.... ..... . ................. :�i H T <br /> /l rc.. rte— -- Io: N _ m � Nm <br /> Inspection Date ....................................... ......... ..... ........ .. ..............*�.................. o; .u' m <br /> Zonin Administrator 8 8 8 8 8 8 V7 <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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />