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Burnett County Office of Zoning Administrator d 0 0 <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 located as '� o :S <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use Z <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 0 <br /> ....` Q.!.� <br /> ...........................................................SC-{'U/CSS Se' 3 <br /> ........................................................................ <br /> OWNER (please print) SURVEYOR <br /> � _ <br /> CONTRACTOR or SU RVEVOR or AGENT m otm <br /> ....�X...�° .... s .,.....67V'i a 4J> (T <br /> ADDRESS ........................ . ....................................................................................... <br /> .. <br /> ADDRESS <br /> ........................................................................................... . . ........................................................................................ <br /> i 1 <br /> ADDRESS ADDRESS <br /> O <br /> ' :N <br /> ........... 64..-.Yd.................................................... <br /> PHONE . .......................................................................................... <br /> PHONE <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... ............................................................................................ <br /> O <br /> Z <br /> ADDRESS ADDRESS 'C <br /> m 0 <br /> < <br /> PHONE <br /> PH ONE <br /> 0 <br /> ....................................... ....................................... o .; <br /> r <br /> DESCRIPTION o o <br /> 4. SanitaryFacilities: <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building ,x„ Type of Construction: No. Bedrooms .......... <br /> m <br /> Addition . . ............. Septic Tank Size Gals. .......... <br /> Sanitary .......... Size Zv. .., ft. x .s3.P. ft.x3oytSeb <br /> Rillingt Grading .....,,,,, Height...//....... Stories ....�......... 4a. Absorption Field Site: <br /> Moving .......... Area ...,tR..y ...........I........... Soil Type ... .�............................ <br /> Mobile Home .......... Slope ......./ yf}........ .......... ._ U� .0 <br /> Privy .......... 3. Use (describe exactly, i -family Pere. Rate .....W.olG/!n. .. .... oQti,rC i <br /> ffnn <br /> Well h me,garage motel, etc.) Dry Well .......... *VI <br /> Subdivision .......... �j � S �! Seepage Trench .......... <br /> .......... <br /> Camping Unit ski✓�'-K.. ................................ Privy ......... <br /> ...... ?I <br /> Seepage Bed <br /> ----------------------- ----------------------- ------- �0_�^v0 .N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig A. Include road]T d <br /> setback, side and back <br /> yard dimension and location and setback from all bodies of water- If property is located at a highway Inte - J Ifl d <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTIN T`1 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --------------------_------_---_---------------------_----_.--------- -_—f <br /> 5. Lot Size: Fig. A. 6. L9qcajyion' <br /> ft. x .............. ft. — ............................... sq. ft. L& SG 7 0�(�:%sT/, -e css <br /> 0 <br /> .............i... ................................. <br /> CK'rSkh, :O <br /> 4 �b <br /> W <br /> o � <br /> 0 <br /> See <br /> T Cn1 <br /> Z <br /> �� 6wkl�Q <br /> �IaN app,-ad <br /> ail <br /> M rn aid W <br /> n �y rra < <br /> -O � aC : < m my <br /> „ 0 am <br /> Z o o' <br /> n 70 <br /> o <br /> v, <br /> .. . . ..................... <br /> Sig ature of Owwner o gent Date / y o p <br /> Remarks .......................... T <br /> .......... 'n't� eat I x P n.� X O <br /> 'Ullvll .. ........ <br /> V <br /> Ass <br /> ..... .. .. ....._ �-= .............. ..... .. . . �. .. . . .... .. <br /> r .. .. ..... . . <br /> ...................................... ....... ........... <br /> m <br /> Inspection Date ....................................... ro ro a m <br /> .. .. .. .. .... .... .......................................... l: U N O N fT <br /> M <br /> Zoni Administrator tj g o 0 0 � ti <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faciliti a <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached o <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 We made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />