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Burnclt County Office of Zoning Administra or go c <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 nd Oy` <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he �$ <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 `� <br /> regula ns q'�the State of Wisconsin. II �j F: a <br /> . "EW7 . ....r.f. ..... ........................... �............... ................... ...orSUR EYOR.�....:................................. ..... <br /> OWNER (please print) ) CONTRACT R or SURVEYOR or AGENT � i0 <br /> ...!r.. .........................l..tY... .....d tie.....`........................ ..........:�.t...1...........x:.................................................. . _ ' A <br /> ADDRESS, AD[ S o. <br /> �/ �\ t <br /> .... .af-Al.4....11h...::1...:....... .. 11�J................. ........,...!: .h..............r 1 J �.....: .Y. ` Y�....... ..... r ' <br /> ADDRESS ADDRESS 'q <br /> 8(, t% .7.y.°.............. r�L 1 <br /> .. .................. ..................................................................... ... .......................... <br /> PHONE PHONE <br /> " <br /> . ..................................................................... . <br /> PLUMBEE <br /> . . ................ ............................................................. ...... <br /> R WELL DRILLER <br /> O <br /> ADDRESS ADDRESS m 0 <br /> ti <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: = o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> """"' c <br /> Naw Building ..y... Type of-Construction: No. Bedrooms ... <br /> Addition .jlci S` Septic Tank Size Gals. ... ...... C10 a <br /> Sanitary ... ;... Size ....a1.. .. ft. x ...:3..6.. ft. • ' •f <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: ? i <br /> Moving .......... Area Soil Type ..................I.......... ...... i <br /> . <br /> ................................. . ...... ti <br /> Mobile Home ,,,,...... Slopev ' <br /> Privy ....•.••.. 3. Use (describe exactly '1 -family Perc. Rate ............................ ...... o :1 <br /> Well ...... home,garage, motel,e . Dry Well ... ...... m L <br /> Subdivision .......... Seepage Trench o i T <br /> Camping Unit .................................................... Privy <br /> .................................................... <br /> Seepage Bed o.. . .y <br /> ------------------------------------------------------------------- -- -C-. ^ y <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. ;/L a y� <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at _ I ' <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ___________________________________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ................... . r.�............ .�.a....... ....... <br /> A�f. :L � <br /> N +J <br /> :5, <br /> r ' ``' <br /> Ise- �� T <br /> tayir� 'R v <br /> l� Z <br /> 0 <br /> 6 AJ <br /> d <br /> N C N Cl (Dj m m <br /> m No. < nm nn y <br /> O N < O b n <br /> ZigO D 1 <br /> � n m <br /> _ c <br /> ...... .... . . .............................. t.?.�....�%. ,. �.... x In <br /> Signal re of ner or Ag t Date Ao . <br /> o : <br /> ....... ...=marks ............................................................................................................................................................. . a <br /> . <br /> N <br /> ....................................................................................................... .... ........ ... .................... 8 m <br /> NMN 8 " <br /> tion Date ....................................... ......... .. u u, o, 00u <br /> M <br /> Zoning A inistrator 8 99 8 8 8 V! <br /> rE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities before construction <br /> iegin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> ued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has beer issued. A permit may be <br /> d if misrepresentation of any of the informationconveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> thout approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />