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Burnett County Office of Zoning Administrator v o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < — 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c ^C <br /> Ordinance, anitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. t0a <br /> 3 :G\ <br /> . ] ii h rC <br /> �►L.1...1. <br /> a <br /> a. ' ..........t'{.SY..F.L..d.A.. .................... .......... 1..w..r.........�.. ...r .. ... _ <br /> O NER (please print) A CONTRACTOR or SURVEYOR or GENT a <br /> 3...a.1. w f'.r�!.. 4 .h..Y�lV................ E <br /> ADDRESS ADDRESS <br /> ?stn. ... s:........ ..�.. .. y! ...................... ............................................................................ a <br /> ADD ESS ADDRESS v ' <br /> i <br /> PHONE PHONE :\ <br /> ... ....... . ... . .................... ......................................... ............................................................................................ <br /> PLUMBER Q �� WELL DRILLER '! — <br /> ADDRESS ADDRESS ti o .. <br /> )✓ —. C( <br /> PHONE PHONE Z �^ r <br /> DESCRIPTION 4. Sanitary Facilities: ! ° o °» <br /> 1. Work: 2. New Building Details No. Bathrooms .... .... :311 0 <br /> New Building v Type of Construction: No. Bedrooms ..a�.1. 0 <br /> Addition .....,,,,. C ` ` Septic Tank Size Gals. .......... <br /> Sanitary 3 <br /> Y ...L. Size .. ..y.... ft. x .......tl. ft. i <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ...................................... .... Soil .................................... <br /> � r <br /> o <br /> Grading Slope ....................................... <br /> Mobile Home 3. Use (describe exact) , 1 -famil <br /> Perc. Rate ................................... ;S . <br /> .......... <br /> Privy .., Dry We <br /> ll .........home,garage, motel, etc.) <br /> Well Seepage Trench .......... <br /> fa' `�� i'• <br /> .................................................... <br /> Subdivision Privy �......... <br /> Seepage Bed -QGt` <br /> .......... .................................................... CpE_ '7[, <br /> ;A <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- (1 <br /> R cL <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 1 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. .� , p <br /> -------------------- — — ----------------------------- k1L <br /> 5. L t 9 Size: Fig. A. 6. Location: <br /> ..P.V.4.... ft. x .R V.�.s:... ft. . ............................... sq. ft. ............................................................................... <br /> I <br /> V µ <br /> o' <br /> J <br /> 1 � <br /> :J13 10 <br /> Z .d <br /> o <br /> d <br /> m <br /> Cs' D <br /> nm <br /> c m d <br /> m N°a blAl <br /> Z O 5o <br /> Z OZj <br /> " 1 - w - p <br /> 0 <br /> `...... ....... ............................................... ........... `.... ..7'.... o c <br /> Sign reof Ow r or Agent Date — <br /> X <br /> T i <br /> Remarks ............................................................................................................................................................. m <br /> ............ m p <br /> ea <br /> ........................................................................................................................................................................................ :Oq II <br /> ............................................................................................................................... <br /> E01 : <br /> 00000tnm <br /> Inspection Date ....................................... .!�V....,......... ....riz.:�`.'.........�-�'............................... b b b b b b m <br /> Zoning Administrator 0 0 0 0 0 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitlos <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 plum hing 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 />