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d I , <br /> Burnett County Office of Zoning Administrator K o0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3, <br /> ° <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as � <br /> v <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m m <br /> Ordinance, Sanitati n Cod , and wit ther applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> �lw� Jlt.► ?.f.................. . .......................................................................................... — <br /> a � <br /> ..................................................... .... . m <br /> OWN (please print CONTRACTOR or SURVEYOR or AGENT a <br /> `kJb ( a <br /> ......{�,V:l CI . :.. ................. a <br /> ADD SSADDRESS m ; <br /> ,��w.....1W,.sc - <br /> ADDRESS ADDRESS <br /> .................................................................. . .......................................................................................... <br /> PHONE PHONE <br /> .......................................... . <br /> ...... ...!. ...�Cl .......................................................................................... <br /> . .. <br /> PLUMBER WELL DRILLER <br /> .................................... ............................................... <br /> O <br /> ................................................................................ ...... <br /> ........... .ADDRESS <br /> ADDRESS ,n. 0 <br /> 0 0' <br /> . . . . .......................................................... <br /> .... ... N <br /> ........................................................................ PHONE Z r <br /> PHONE ' <br /> .. ........ . <br /> DESCRIPTION 4. Sanitary Facilities: 0 o <br /> it I <br /> 1. Work: 2. New Building Details No. Bathrooms •� •• o <br /> i a i <br /> No. Bedrooms <br /> New Building .......... Type of Construction: Septic Tank Size Gals. <br /> Addition .. .... ....... .......... ..............I. ................ <br /> Size .... .. ft. x ... �1.. ft. <br /> Sanitary .......... / 4a. Absorption Field Site: <br /> FillinglGrading Height..l.�... Stories ...I........... <br /> Moving .......... Area .......................................... <br /> Soil Type .................................... r <br /> Slope .......................................... -� <br /> Mobile Homei <br /> Perc. Rate ................................... E J- <br /> Privy 3. Use (describe exactly, 1 -family Dry Well <br /> In .......... <br /> Wall garage, m etc.) I <br /> K,s Seepage Trench • • <br /> Subdivision .......... ,r��'e"j��,t- V�. .....•.•... <br /> ....`' It. Privy <br /> Camping Unit .......... ..... .... .. 1.. . hem ..... . .. .. . . J <br /> . .......... . . . . Seepage Bed .......... <br /> ---------------------------------------- <br /> -.` <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road a a <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 <br /> - Lot Size:--------------------------Fi A. 6. Location: � �/ � o •� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS `t <br /> 5. <br /> __ ------_--_-- ------ <br /> }w . ............................... s4, t. y f... . . <br /> ................ ft. x ........ ............................................. <br /> V 3 I o0 0 ?. <br /> 0 <br /> Z pld gld� - p3o.a o s�S <br /> �— d✓er 21%lJ l ��n „ Us <br /> Neel <br /> z <br /> 0 <br /> q0 <br /> ® �7 N r 9 � N z <br /> c E c X <br /> T. <br /> j 02: <br /> < _ £ <br /> -o rn n <br /> m : - m <br /> Z oo � 7p <br /> i» <br /> m <br /> C� Gk ........................ .....�.�..� I� t�.. �a c <br /> Signature of Owner or Agent / Date / / <br /> Remarks ....�./� —X......SG' G-... til.C..... . .Q.u�C=f...../.. �l.llT�./✓1/......GCG{��il�d�................ x <br /> L I ..... <br /> �....... ......................... .......................................... yr <br /> m <br /> ✓(// :% ..' y .... ... ................................ `1 ? of outer o u m <br /> ...�9............................................................. <br /> Inspection Date ... ...... <br /> ✓ o <br /> p ... .... ...... ...... <br /> Zoning Admi trator <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 be made Without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />