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Burnett County Office of Zoning Administrator d o Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < rn <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. 3 <br /> 7 a <br /> ......T... i!z2 ).n. ........h..... .` .. .................. ..........: . ..../........... c <br /> OWNER (Please printl� 4. � v� , ; CONTRACTORor SURVEYORor AGENT a <br /> ��'.. '........1.......::.........1............. ....:................... . . . . . ................................................................................. <br /> ADDRESS ADDRESS .. <br /> 5�.:... S.T... ..... ...r��.r'...................... <br /> ADDRESS <br /> - SS62EL <br /> ADDRESS <br /> T /......................................... ................ ............ . ................................................................................ <br /> ..HONPHONE �>\ <br /> \ � <br /> :(�........ L't...'. <br /> PLUMBER <br /> ...K. ............................................. ............................................................................................ <br /> WELL DRILLER <br /> ............. � <br /> ........... ............................................................................... .A......RESS E'S"S' .............................................................. '� X <br /> ADDRESS DD \\' o <br /> ........................................................................................... ............................................................................................ : o' .: <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: P E 0 <br /> 1. Work: No. Bathrooms <br /> Y 2. New Building Details "••'�- iQJt o <br /> New Building '.l No. Bedrooms <br /> Type of Construction: v ,o <br /> Addition Septic Tank Size Gals. ca ;off <br /> Sanitary <br /> 1peo <br /> ..x.... Size ..........1... ft. x ....lh. .:..ft. .. ....... y .� < <br /> Filling/Grading .....•.... Height............. StQ/ries ....f..� 4a. Absorption Field Site: <br /> Moving 1 .......... Area spy 1 ,¢ Soil Type .............................. i>~: iti <br /> ................. . . l . R^ i <br /> Mobile Home .......... , / Slope .......................................... :K <br /> 6 1 <br /> PrivPere. Rate ................................... I <br /> Privy 3. Use (describe exactly, 1 -family t� <br /> ViAeu .. .... home,garage, motel, etc.) Dry Well .......... ✓� <br /> Subdivision .......... .................................................... Seepage Trench .......... l :� <br /> Camping Unit ,,,,,,,,,, Privy ........,, UI --c.: * i <br /> .................................................... <br /> Seepage Bed . y' <br /> --------------------- ------------- - <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road ° ? <br /> F:[ <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property is located at a highway inter ^ o. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r_ a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :( H <br /> 0 <br /> —————————————————————————————————————————————————————————————————————— <br /> 5. Lof Fig. A. 6. Location: a, 'E� <br /> .../.�..,..... ft. x ....c�....... ft. — ............................... sq. ft. �� <br /> .............................................................................. ^ P <br /> or, <br /> H <br /> N O <br /> O 5rr, O <br /> 3 '1` <br /> :W <br /> O :CS <br /> V V O <br /> � J <br /> J <br /> C N <br /> Z <br /> all <br /> n �twrr <br /> n ur <br /> I� <br /> 7,7 n <br /> w m <br /> z o o D n m <br /> O n�' <br /> 61 <br /> 0 <br /> �r �o c <br /> Sl nature of Owner or Agent Date <br /> X S <br /> Remarks ..O —z�: :�-- TI : : m <br /> ............................................................................................................................... . . 0 <br /> m <br /> ............. . .. .../......................................................... <br /> ...................................................... <br /> G .I <br /> .......... :: .. ............................... Y", <br /> o . <br /> .. ... 8: , N m N m <br /> Inspection Date .....Q...�........�r. :3........... ..?rzGO/.:..... LQ?:kb:F3'Z?!4. : ` : o a o v, o v, m <br /> Zoning Adminis rator 888000090 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faCllitwS <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 Adm Inlstratol. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />