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Burnett County Office of Zoning Administrator0 01 73 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 o J <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. E a <br /> O <br /> ..................................... ... ... ................................................. <br /> ... ...... ........... � � <br /> OWNER (please p.rint).. ... ..... CONTRACTOR o.r S..U.RVEYOR or AGENT <br /> I. ..y.S.s............1.. ..... .�;...................... ......... . . ...... . ............................................................................... a <br /> ADDRESS ADDRESS <br /> (° .. .�g..r. ..,...3-✓1..h..............5..s.3aa........... ............................................................................................ <br /> A /RS , / ADDRESS <br /> CeEBx.0 <br /> .l. �....`f.`f .. .a�T:S4................................. ............................................................................................ :\ <br /> PH E / PHONE -M !� ? ) <br /> .... .................... .. ........ .... .............................................. ............................................................................................ <br /> PLUMBER / WELL DRILLER ;� <br /> ................ <br /> ADDRE ADDRESS 6\ m .� <br /> n ° <br /> s- Z. <br /> PHONE PHONE Z a, r <br /> DESCRIPTION 4. Sanitary Facilities: ' v o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details :� o <br /> New Building No. Bedrooms <br /> Type of Construction: ... ."• :b\ � <br /> Septic an Size Gals. .......... p <br /> Sanitary ,Addition },(,..... Size ft. x ft. L "l �` � <br /> Filling/Grading ,......... Height............. Stories ............... 4a. Absorption Field ite: .� <br /> SoilType .................................... r <br /> Moving .......... Area ........................... . n '� o <br /> MobileHome Slope .................................I........ _ <br /> Perc. Rate ................................... t :� <br /> Privy .......... 3. U (describe exactly 1 -famil E� <br /> Well .......... om garage, motel, etc. Dry Well .......... F <br /> Subdivision <br /> Seepage Trench """"" <br /> = ' <br /> Camping Unit .......... .................................................... Privy .......... :� \i <br /> Seepage Bed .......... k :,,^ <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 'mmc .0 a <br /> section, show the intersecting highways and the setbacks required along them and it the intersection. CLEARLY LABEL EXISTING <. o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O ' o <br /> _. ..._ <br /> _______________________________________________________________ <br /> 5. L t Size //-- Fig. A. 6. Location:�. : !!l�ft. x .CSI. t/ ft. . ............................... sq. ft. ............................................................................... ` <br /> N <br /> �^t m <br /> 0 <br /> O I O. <br /> o � <br /> �s 0 <br /> 3 <br /> (ti S <br /> T VV <br /> Z <br /> :p ° <br /> n <br /> IZ <br /> 7 N r a .y Z <br /> a n < m F <br /> a ern < C <br /> mm <br /> Z o o D n <br /> o n ° <br /> to <br /> D � <br /> 1�, <br /> .... .................................................... �/ <br /> ............. .. <br /> :W\o : C <br /> Signature of Qyyner gr Agent Date X M <br /> R �l ) /emarks ... .�. ..1.....:.................................................................................................................................................... � m� <br /> ....................................................... <br /> w ' <br /> — <br /> G <br /> ....................... <br /> .............................................................................. .... .. c: T <br /> Inspection Date ....................................... .....h?,� . .............. ............................. u o N o m <br /> Zoning Adminl trator ,rJ : 0 0 0 0 0 <br /> 0 0 0 0 0 <br /> NOTE: A preliminary site inspection must be made and site appiovol granted on all structures involving sanitary faCilitn" <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test rnust be attached to <br /> this application before a permit will he 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 />