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Burnett County Office of Zoning Administrator W CD 0 0 <br />APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 0) 3. <br />o <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� v> �^ <br />shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CCD c �j <br />Ordinance, Sanitation Code, and with all other applicable County Ord' antes and the laws and regulations of the State of Wisconsin. 3 a <br />O <br />�"!✓soA/ EQPL,S CaNC/ViSNRY ........................... <br />....... y :n <br />.. <br />OWNER (please print) CONTRACTOR or SURVEYOR or AGENT CD <br />xg a <br />..y............................................................ w£............R...'.................................................. ,,nn <br />ADDRESS ADDRESS CD :i�J <br />s.r... / ...... ' ..................................................................................................................... z <br />:a <br />v...�.... 1 9 ^� <br />ADDRESS ADDRESS <br />.............5........................................................... o <br />PH...NE......................... :\ <br />PHONE <br />DN <br />................................................................ <br />.......<...%...'...../...{.................................... WELL DRILLER :� �l1 <br />PLUMBER <br />0 <br />ADDRESS ADDRESS 0 o <br />o' <br />PHONE PHONE Zti r— :p <br />DESCRIPTION 4. Sanitary Facilities: ° o ° <br />1. Work: 2. New Building Details No. Bathrooms J o <br />New Building X.... Typ Constr tion: No. Bedrooms r� <br />Addition F6,I�}-r -- , Septic Tank Size Gals. <br />CD v€ <br />.......... . ...... ..... <br />Sanitary O o........ <br />Size .......... ft. x .............. ft. <br />4a. Absorption Field Site: <br />Filling Height.... .... Stor}}'��s ../.......... O: <br />gD5'.t t Soil Type....................................Moving Area.�....................... r <br />o <br />GradingSlope .......................................... f <br />Mobile Home Perc. Rate ................................... <br />,.,..,.,., 3. Use (describe exactly, 1 -family � <br />Well We """"" <br />Privy he, garage, morel, etc.) Dry 14 <br />Seepage Trench .......... WWell `Ce5.44.0.4........................ <br />Subdivision Privy .......... i <br />...................................................... . . <br />Seepage Bed <br />.......... <br />---------------------------------------------------------------------- <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- <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 />------------------- <br />5. Lot Size: Fig. A. 6. Location: <br />L0.Q•.... ft. x .I.V v, ft. — ............................... sq. ft. <br />�► P K �E <br />70 <br />;20 <br />rP7�� <br />aG. <br />f <br />J°�� ✓A -TF dA� <br />.........................../�.��.%�..... <br />Sig*atueOwner Agent Date <br />Remarks......................................................................................................................................................................... <br />Inspection Date <br />Zoning Admi strator�rJ <br />�.; <br />c <br />s <br />N. <br />0 <br />Co <br />r+ <br />N <br />o <br />O' <br />W�w <br />0 <br />O <br />•i <br />N <br />� <br />a <br />`• <br />CD <br />'Q <br />Z <br />0 <br />m <br />cnr-0:ENoO <br />CD CWCD 03 CD <br />M Naa`t <br />aLn <br />< �: <br />oHH <��m <br />Z 00 ' fD fD <br />o <br />CD M <br />�s c_ <br />X <br />CD <br />M <br />CDu <br />r» T <br />o 000LOT, oLTjlM <br />0 o 0 0m <br />000000(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 />