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Burnett County Office of Zoning Administrator v _ o / o <br />7 <br />APPLICATION FOR SANITARY —LAND USE —BUILDING PERMIT �' 7 <br />o ~� <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < y * :U <br />shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br />Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. :;10- LlJ <br />— v <br />�.r........................ ...�? !n..;........................................................... � o <br />OWNER (please rint) CONTRACTOR or SURVEYOR or AGENT m gi <br />. ... W....L.y.�..... �................................................................................................................. 'a <br />ADDRESS M ADDRESS m <br />V <br />N,� r� <br />ADDRE S ADDRESS ' <br />� 7 ' <br />PHONE PHONE <br />PLUMBER WELL DRILLER <br />R <br />ADDRESS ADDRESS <br />..................... .... <br />.*. <br />PHONE <br />DESCRIPTION <br />1. Work: <br />New Building <br />Addition <br />Sanitary <br />Filling <br />Moving <br />Grading <br />Mobile Home <br />Privy <br />Well <br />................... <br />PHONE <br />........................................................... <br />CD <br />0 o <br />........................................................... z o' 1- <br />7 <br />r <br />4. Sanitary Facilities: ` ° 0 <br />No. Bathrooms CIt <br />No. Bedrooms L <br />Septic Tank Size Gals. <br />4a. Absorption Field Site: <br />SoilType .................................... <br />o <br />Slope <br />Perc. Rate ....................`...�.Q... <br />Dry Well .......... In <br />Seepage Trench ......... <br />Subdivision..........:.....G.f�.'........... Privy �.........y <br />Seepage Bed l8 X3.. <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- Z+ (r <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 />-- — — — — — — — — — — — — — — — ——' — _ 7 <br />---------------------------- <br />5. �Qize: d <br />Fig. A. 6. Location:C �%%v I�- �L ! �,{ <br />!. r ..V .. ft. x'j .. V. ft. — ...�.�v.�....� sq. ft. C. ..��.. el f'!!.. .......... <br />�. <br />`° <br />N 0. <br />Lo <br />41 0 <br />Bill <br />Ct00 <br />M <br />CO <br />C: CD <br />7-• <br />lT1 Q NQ Q< -f- <br />1 -0 <br />', •S Z O p' mOL <br />On'oe�r' <br />............. ...... .....`'.. ��." .. : o p <br />ignatureof or Agent Date - — <br />J. X 0 <br />Remarks ...1/G' .... .c�Q......................................................................................................... -n � <br />a <br />C _ <br />`. ... .:.............................................. .......................................... I................ " �~ <br />° o00 ocNiiM <br />Inspection Date.a.......................-???:�p.....f ?.�.....?cJ................. <br />ZoningAdministrator � 0 0 0 0 o 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 be made without approval of the Zoning Administrator. <br />SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />2. New Building Details <br />....... <br />Typ� f Qonstr ction: <br />... ..... <br />(/... <br />..... '............... I..........�.b.......... <br />Size .....�'.:`..... ft. x ..'......... ft. <br />.......... <br />Height ............. Stories .... �......... <br />.......... <br />Area ........................................... <br />.......... <br />3. Use (describe exactly, 1 -family <br />home garage, motel, etc.) <br />........................................................... <br />CD <br />0 o <br />........................................................... z o' 1- <br />7 <br />r <br />4. Sanitary Facilities: ` ° 0 <br />No. Bathrooms CIt <br />No. Bedrooms L <br />Septic Tank Size Gals. <br />4a. Absorption Field Site: <br />SoilType .................................... <br />o <br />Slope <br />Perc. Rate ....................`...�.Q... <br />Dry Well .......... In <br />Seepage Trench ......... <br />Subdivision..........:.....G.f�.'........... Privy �.........y <br />Seepage Bed l8 X3.. <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- Z+ (r <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 />-- — — — — — — — — — — — — — — — ——' — _ 7 <br />---------------------------- <br />5. �Qize: d <br />Fig. A. 6. Location:C �%%v I�- �L ! �,{ <br />!. r ..V .. ft. x'j .. V. ft. — ...�.�v.�....� sq. ft. C. ..��.. el f'!!.. .......... <br />�. <br />`° <br />N 0. <br />Lo <br />41 0 <br />Bill <br />Ct00 <br />M <br />CO <br />C: CD <br />7-• <br />lT1 Q NQ Q< -f- <br />1 -0 <br />', •S Z O p' mOL <br />On'oe�r' <br />............. ...... .....`'.. ��." .. : o p <br />ignatureof or Agent Date - — <br />J. X 0 <br />Remarks ...1/G' .... .c�Q......................................................................................................... -n � <br />a <br />C _ <br />`. ... .:.............................................. .......................................... I................ " �~ <br />° o00 ocNiiM <br />Inspection Date.a.......................-???:�p.....f ?.�.....?cJ................. <br />ZoningAdministrator � 0 0 0 0 o 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 be made without approval of the Zoning Administrator. <br />SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />