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Burnett County Office of Zoning Administrator ' 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> < a <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as — ::(�zc <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use 1 c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> or 0 <br /> �:,.h,.. ....... ........................... ....................... ... ..... C a � ........... ........................ 3 <br /> OWNER (please pri t)` I CONT ACTOR r 5 RVE R or AGENT a <br /> x '"/ I /AVI I \ ' ((xx7� r�`'�J��( �/' <br /> AD ../ S[........................±..:. �.......y.( ......4...7........ ........!:�V/..1.....9 ......................................................... <br /> 1 . ADDR S � p <br /> a. <br /> RFSS . .. ..... .. ... . ...... ....... ..... .....DRFSS ... 11:3..................... <br /> ADDRESS ADDRESS f <br /> �. <br /> PHONE . .......................................................................................... ! t <br /> PHONE <br /> PLUMBERE.LL....DR....IL.... ..................................................................... <br /> WELER.... <br /> ........................................................................................... . .......................................................................................... O <br /> ADDRESS ADDRESS or CJ <br /> in O <br /> 0 c <br /> . . .................................................................... PHONE <br /> PHONE t <br /> z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> o <br /> New Building .......... Type of Construction: No. Bedrooms .......... c <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ft. x .............. ft. .......... <br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r <br /> ........................................... <br /> 0 <br /> Mobile Home .......... Slope .......................................... .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Pero. Rate .........................I......... i <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench ...I...... I <br /> Camping Unit .......... Privy .......... <br /> ................................................... Seepage Bed <br /> or <br /> Location of proposed structures and existing structures, well, sewage systems,.roads etc., should be sketched in Fig. A- Include road <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. o <br /> ------------------------_--__---- i <br /> 5. Lot Size:----------------- --------Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. Q <br /> 1 01o <br /> N <br /> I 1, <br /> IF 0 <br /> o <br /> z Z <br /> o <br /> 11`i <br /> y' <br /> 77 N r 9 f/l to Z <br /> n Q <br /> m N d 4 d ¢ to <br /> b <br /> zoo' � yam <br /> o `cn aro <br /> �b J <br /> O� m <br /> .................gen'............................... ...................................... o p <br /> Signature of Owner or Agent Date <br /> X// 7] <br /> Remarks ......................................................................................................................................................................... :W m <br /> M <br /> ........................................................................................................................................................................................ c» . . . . . . <br /> ... <br /> Inspection Date //��C,f7j(2QJ / ..., <br /> ....................................... `�rRrL .. .................... ..... . ........ u�i u o N o cNNn m <br /> 6 m <br /> Zoning Administra o o $ $ g o W <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 Admimstratoi- <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />