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Burnett County Office of Zoning Administratoro 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 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m j <br /> O,rd/finance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 ec <br /> O <br /> 4//l.>✓ ..................................... ..................wS�.h��.., ............ C _ <br /> o C <br /> G <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> ........................................................................................... d U <br /> ADDRESS fl1.11rF4 xPAX-33 r/ l ADDRESS V <br /> ........................................................................................... .......................... ... <br /> ..... .......................................................... <br /> ADDRESS ADDRESS <br /> PHONE PHONE <br /> ........................................................................................... . . . ..................................................................................... � <br /> PLUMBER WELL DRILLER ?� $ <br /> 0 <br /> .... . .............................................................................. . ......................................................................................... -. <br /> ADDRESS AD.. DRESS 0 o <br /> ........................................................................................... ............................................................................................ o .e <br /> PHONE PHONE Z � r. <br /> 0 <br /> DESCRIPTION 4. Sanitary Facilities: itle-lcl ' 0 C 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o ap, <br /> New Building ✓' T e-✓ce^ o. Bedrooms .......... z ' <br /> .,,,,,..., <br /> Type of Construction: O S`ruc m it <br /> Addition ......c.j59S�rza Septic Tank Size Gals. .......... i E <br /> .......... .. <br /> Sanitary .......... SI2e ...Jd•...... ft. x ft. .......... <br /> (Gradin 4a. Absorption Field Site: <br /> Filling g .......... Height....'......... Stories .............. <br /> ......... Soil Type .................................... r i <br /> Moving .......... Area .................................. :^ o <br /> Mobile Home .......... Slope .......................................... a :C <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... �7 : <br /> Well .......... home,garage, motel, etc.) Dry Well .......... � 4 i <br /> SubdivisionSeepage Trench .......... 1 r° <br /> .......... ...cdt'dP.RS/.c............................. E <br /> Camping Unit .......... �- Privy .......... <br /> .................................................... <br /> Seepage Bed .......... 9a. <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. It property is located at a highway Inter t o- <br /> section, show the intersecting highways and the setbacks required alone them and at the intersection. CLEARLY LABEL EXISTING :0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> .-_.._- ---------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> (E 0.. ft. x ..�7�.. ft. . ........... � sq.ft. —.X .. .!.!. . <br /> G <br /> O <br /> or, <br /> o <br /> 0 \ o' <br /> o <br /> l � <br /> 7 0 <br /> DR Q <br /> , � s <br /> r_ <br /> U� 37' <br /> M Von- aW I <br /> n Q < � Z <br /> _ w c m <br /> m Na L n: w W <br /> m — m <br /> Z05 n 70 <br /> 0 0 a e 3 <br /> En - <br /> � o <br /> vel owl m <br /> e .. . ............................. .............. o._ s' <br /> nature of Owner or Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... m m <br /> � O <br /> A <br /> r <br /> ........................................................................................................................................................................................ . <br /> .... . ..�... ..... .. ... .. m <br /> m <br /> InspectionDate ....................................... ....... ............. ... .....9... ry. .....-........................ p; u rn o u. olin l� <br /> Zonin mistrator 8 8 8 8 8 !n <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 Ire made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />