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Burnett County Office of Zoning Administrator iu o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 :>. <br /> » <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as ° <br /> '� — <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> ol/a ..................................... <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT <br /> ............. as <br /> ...........ADDRESS ....w.1L1..�.�t.xrs........l,,u..a..0�.5........ .......I�.1.`1................. .......................................... <br /> ADDRESS ADDRESS <br /> r •'c�— <br /> ,I '....... ........t?.rl.... 55NS..... �✓ ... . ......4d.........vl�sd .d <br /> f� ...... <br /> ADDRESS ADDRESS I %m <br /> 5-7 <br /> ............................... <br /> PHONE PHONE <br /> ........................................................................................... ............................................................................................ �. <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .4 <br /> ............................................................................................ <br /> ADDRESS ADDRESS m 0 .1 <br /> o <br /> PHONE PHONE <br /> DESCRIPTION ° o » o <br /> 4. Sanitary Facilities: o » i� <br /> 1. Work: No. Bathrooms Ei <br /> 2. New Building Details •• •• •• ° sa <br /> New Building Type of Construction: No. Bedrooms .. ... y <br /> Addition ,.,,,,,,,(�JVQQ.....,F.(�!t?Za.,,...... Septic Tank Size Gals. <br /> .......... <br /> /�w'.. ft. x ... ... . ft. .......... h: <br /> Sanitary .......... Size ...... -�'... .`r <br /> Filling .......... Height..�iQ.�... Stories ...I.......... 4a. Absorption Field Site: <br /> Moving Soil T <br /> ype ..................... <br /> .......... ......, ....................... ............... <br /> Grading Slope o <br /> .......... r i <br /> t <br /> Mobile Home .......... 3. Use (describe exactly, 1 •family Perc. Rate ................................... <br /> W <br /> Privy home garage, motel etc.) Dry Well .......... u <br /> Well ���' .�)ysci Seepage Trench <br /> �1......... ................. y <br /> Subdivision .......... "' Priv ' ( ' <br /> .................................................... Seepage Bed <br /> Y <br /> ___________________________________ .N <br /> Location of proposed structures and existing structures,well,sewage systems, roads etc.,should be sketched in Fig. A. Include road IJ e <br /> setback, side and back.yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ° a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 0 <br /> -------------------:_--_--_—_-------___—__--- —_ <br /> 5. Lot Size- )�,�y Fig. A. 6.. Loc/action: ,q� ` '• <br /> ....I.G. .. <br /> it. x .��.. ft. — �i.. '.K..X. sq.ft. .....F.fl j{iGtf/•c,:t,....ViLf. ..vy<......�/.ttR .f...... <br /> b' o <br /> o � W <br /> s <br /> T ' <br /> ,15r �- <br /> r►°'t� <br /> Cc,WrZ <br /> < — ' aF <br /> 0 � < c m <br /> Z o o' <br /> .sem,o <br /> m <br /> . S......-1.................. <br /> Signature of wner or Agent Date ° <br /> X i 37 <br /> Remarks .., e:i.•1e�,.hg..b:1.. ..,J. ..4 { '��:..��? ............................................................................................. E f <br /> iJ T m <br /> ........................................................................................................................................................................................ <br /> �. ." <br /> /jam J .................... Q N <br /> Inspection Date ....................................... %(/ ,'A'* <br /> 0000 om <br /> Zoning,ddministrator ° ' 0000 o y <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 />