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L/ <br />Burnett County <br />Office of Zoning Administrator -- z <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 and located as <br />o <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 C e, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br />��S ? o <br />h�.....p..r..........�1. *'r. <br />..................................... ........CONTRAC...TT .OR.. <br />OWNER (Please ................SURVEYORRor A. -o-r-...GENTT ............................... H <br />� ..or A <br />ADDRESS­D <br />..ADDR.....E...SS.................................. <br />.... ........................................ m <br />Q _ 1 <br />m l <br />ADDRESS...R....ESS............................................................................... <br />ADD <br />PHONE <br />ON•••• '•'•••• <br />.......................................................................... \ <br />PHE :•oma <br />PLUMBERWEDRI.....R..................................................................... <br />LL LLE <br />ADDRESS'A-D"....S.............................................................................. o C`�� <br />ADDRES....- <br />PHONE.................................................................................. o 0 0�! <br />PHONE..... <br />DESCRIPTION 4. Sanitary Facilities: z o 0 :4, <br />1. Work: 2. New Building Details No. Bathrooms -0 <br />New Building ...... Type of Construction: No. Bedrooms L <br />Addition ++��, ."-q C^ <br />`.. p fD <br />I ...... Se tic Tank Size Gals. .......... <br />Sanitary Size ft. x :'X!�...... ft. .......... c i <br />Filling/Grading ..... I.... Height Stories 4a. Absorption Field Site: <br />Moving Soil Type <br />.......... Area ................................... <br />- <br />Slope o <br />Mobile Home .................................................... \ ,�+ <br />Privy .......... 3. Use (describe exactly, famil Perc. Rate ................................... <br />Well .......... home, garage, motel, etc. Dry Well <br />Subdivision •......... Seepage Trench <br />.................................................... <br />Camping Unit Privy .......... W <br />Seepage Bed <br />Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road N <br />setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway ) <br />g y 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. H' <br />�o <br />5. Lot Size:Fig. A. 6. Location: ' <br />................ ft. x ft. �`-'r'e ' <br />- .......................�.... sq. ft................................................................................ o <br />to <br />Cb <br />N 0' <br />0 3 <br />r c� 0• <br />: <br />0 <br />Z S <br />Q <br />a o <br />v <br />CD <br /><c <br />r) 6 CL <br />'0 Ln < C '< <br />Z oo•� D .m <br />CL <br />0 ifl� a <br />C <br />......................................................................................... o <br />g at re of Owner Agent Date 0 C <br />11 X 70 <br />emarks ................ -n m <br />.................................................................................................................................................... CD . : . . : • O <br />CD <br />..................................................................................................................................................................................... - . . : <br />........................................................................................................ <br />\o. . . . T <br />spection Date.............................................................. ' o o Ln o o m <br />0 m <br />Zoning Administ ator 0 0 0 0 0 0 <br />)TE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br />lore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br />s application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br />-f;) a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here - <br />;h iS found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br />SEWFA SYSTFM SWALL NDT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />