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,� , r <br /> Burnett County Office of Zoning Administrator C 0 0 <br /> . APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TCJ THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as o :�� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c - <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and thee.llaaws arrnd regulations of the State of Wisconsin. M <br /> T. . o ..... ..... . ...................... ................ .4....►.. ............. ........................ m O <br /> ry <br /> 3 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT :f <br /> a. ....E.,..��a..e,.;.A...�c,r.�.��r....AV-.4 ........ ........................................................................................... f. <br /> ADDRESS ADDRESS <br /> :O Ci <br /> ADDRESS <br /> .5.�..:...(�.B.uLf../m.l�t.iu:...5:SLI.�..... ........................................................................................... <br /> ADDRESS ADDRESS <br /> / .i.a. ...... .Sl..- .` . �3................................ ... . . . <br /> PH NE PHONE <br /> 1 <br /> C <br /> XL WELL DRILLER : <br /> ...6.f. ... .............................................................................. <br /> SS ADDRESS 1 0 <br /> . . ................................................... ..J.......... <br /> ..... ... ........................................................................................... 0 <br /> PHONE I ..�-IONE Z N r <br /> 7 <br /> DESCRIPTION _01, ° o•4. Sanitary Facilities: o <br /> 1. Work: No. Bathrooms - . _ . . <br /> 2. New Building Details - •'•• � o <br /> New Building ..,.x.. Type of Construction: No. Bedrooms .... ... <br /> Addition ,,,,,(,',a, �N.......... Septic Tank Size Gals. .... ..... E5 <br /> aC. ;.` <br /> Sanitary Site .��..... ft. x .�.�..... ft. 7E <br /> .�.. 4a. Absorption Field Site: <br /> FillinglGrading ,,,,, ,,,, Height.......h..... Stories ... ..�a..... <br /> Moving .......... Area ....�.�.'L�. SQ.FZ-fia......... Soil Type .................................... m i <br /> Slope .......................................... �': o <br /> Mobile Home P � <br /> Privy .......... 3. Use (describe exactly, 1 -family Parc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> .......... ....S.C.ASaIuA.L... �.�N Seepage Trench ........... <br /> Camping Unit .......... ............................ Privy <br /> Subdivision CA. ....... <br /> -------------------------------------------------- Seepage Bed--------`8 - <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 s located at a highway Inter- <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING Q cy: < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -------------------------------------- o' <br /> 5. Lot Size: Fig. A. 6. Location: I ; <br /> ................ ft. x .............. ft. — ............................... sq. ft. ...... .... ... . ..................... .4 <br /> C' <br /> y ' N S o. <br /> u <br /> I <br /> o <br /> h� r <br /> a � M <br /> cl <br /> C <br /> � vV <br /> M v T : dmz <br /> NP R0 <br /> Pct` � I ° � D � aa3 <br /> o C <br /> Signature of Owner or Agent Date X S <br /> \ : <br /> Remarks ........................................................................................................... ..........................................::.............—A v <br /> v ' <br /> —.II <br /> ........................................................................................................... ..... ...... . .. .............. <br /> Inspection Date ....................................... .... . ....... ,/ �—� <br /> . ... ............. ............... <br /> ..... .. . ........�.. ..y. . . .. .. .... ....... . ....... . <br /> Zoninto <br /> cl�P,dministrar g o 0 0 <br /> NOTE: A prelim inary 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 he'(- <br /> with <br /> erdwith is found to exist. Changes in plans or specifications shall not be made without approval roval of the Zoning Arlministratol , <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />