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ON COMPUTER/SCANNED` <br />Burnett C�Office of Zoning Administrator �' c <br />APPLICATION FOR SANITARY - LAND USE - BUILDING PERMITlm 3 w <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and •2 � <br />located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c p <br />Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 � <br />regulations of the State of Wisconsin. a P <br />...........F.enny... K ing.........................................................................................................................................I.......... <br />OWNER (please print) CONTRACTOR or SURVEYOR or AGENT $ <br />.k� .,.........Box 4 Q ................... I........................... <br />ADDRESS ADDRESS <br />1 :b <br />ADDRESS ADDRESS D <br />�C <br />--.................................................................................................................................................................... <br />PHONE PHONE <br />Donald Daniels 04: otl <br />.................................................. <br />PLUMBER WELL DRILLER �--� <br />Box W Siren, WI 54872 p <br />.......... <br />ADDRESS ADDRESS o <br />715-349-5533 ` <br />P-40" <br />..............................................................................................NE.................................................................................. 'Z N• r - <br />PHONE <br />DESCRIPTION 4. Sanitary Facilities: °r o ° <br />1. Work: No. Bathrooms <br />2. New Building Details "2""" c <br />New Building .......... Type of Construction: No. Bedrooms <br />,Existing,,,,,,,,,•,,,,,, Septic Tank Size Gals. 7.50.... <br />Addition .......... ......... <br />Sanitary X..... Size ft, x ft. """" <br />"" 4a. Absorption Field Site: x <br />Filling/Grading .......... Height ............. Stories ............... <br />Soil Type sand P. � <br />Moving.......... Area ............... ......................... d� c <br />Mobile Home <br />Slope _ <br />.... '* <br />Privy .......... 3. Use (describe exactly, •1 -family Perc. Rate........................3......... i <br />Well .......... home, garage, motel, etc.) Dry Well <br />n <br />Seepage Trench IM P <br />Subdivision s,ingle,,family.................. o il <br />Camping UnitPrivy tZ <br />0 <br />.............................................................. <br />Seepage Bed ..x...... K , <br />Location of proposed structures and existing structures well sewage systems, roads, etc. should be sketched in Fig. A. C7 <br />Include road setback, side and back yard dimension and location and setback from all bodies of water. If property is located at :cu' <br />a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection.; <br />CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br />---------------------------------------------- w <br />5. Lot Size: Fig.A. 6. Location: a <br />................ ft. x .............. ft. - ............................... sq. ft................................................................................ �5 <br />Iv � <br />- � A <br />ID <br />N O <br />O M 7 <br />_7 <br />p :I <br />N• :I <br />.r :l <br />see attached plan —4 <br />:1 =r <br />t� <br />:0 <br />E" Z <br />W o <br />tD d <br />b :z� <br />t+ <br />m c M w 0)r- <br />ri 0 W m <br />n 69 Q< 7 7 0 -• -- ITi <br />C �a< --CLCD aa� <br />�,==3 <br />�00 o�� <br />Z5 6 o CD D -i <br />Ln to a . <br />C, a <br />0 <br />- c :.... . �. ...... A :: m <br />............................................................ <br />Signature of Ownnerr or Agent Date <br />Remarks . 'l.f. ...G�17J'-Cys CDCD <br />v+ : Ln <br />........................................................................................................................................................................................ 0 <br />o <br />........................................................................................................ <br />mInspectlon .................... %'•' mDate /Q.... ...' <br />Zoning Admini <br />r for o 00000 <br />( <br />NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br />can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to this application before a permit will <br />be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br />revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br />made without approval of the Zoning Administrator. <br />SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />