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Burnett County Office of Zoning Administratorfo, Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <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 T c ��^\ � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 M •>✓i <br /> ............................... ....../ . . ...� .{!,(i��I�... H m <br /> OWN! (please/print) / CONTRALTO r SUR E`/"CJR or AGENT M. _ <br /> .....r �'PiQf <br /> I....................... .. ,1 .... a <br /> ADD SS ADDRES O1 <br /> r. <br /> ADDRESS ADDRESS <br /> ..........E................................................................................. i <br /> PHON . .......................................................................................... .� <br /> PHONE <br /> PLUMBER .WEL....... <br /> L...D.RI...... ..................................................................... <br /> LLER.... <br /> ........................................................................................... <br /> ADDRESS .ADDR..........ES................................................................................ p <br /> S m 0 <br /> ........................................................................................... ................ ... . <br /> E < <br /> PHONE ........ . . ................................................ Z <br /> � <br /> .............. `0 �. <br /> PHON <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> .......... d <br /> New Building No. Bedrooms 0 <br /> .......... Type of on�'truo+on_: .......... <br /> Addition 7d1 T/F( � Septic Tank Size Gals. .......... <br /> F^ .......... < <br /> L/P .... ..... pp <br /> Sanitary .......... Size ..... ... . ft. x ....0........ ft. ' <br /> Filling/Grading .......... Height..p..�.["'Gp.+Stories .��. ``.,--....... 4a. Absorption Field Site: <br /> Moving .......... Area .......J:P �.Sr..,7T....... Soil <br /> ..... Type .................................... <br /> Mobile Home Slope ............................ . .o <br /> .... ... r <br /> i <br /> Privy „/.�.... 3. Use (describe exactly, 1 -family Perc. Rate ................................... - E <br /> well ........., home,garage, motel, etc.) Dry Well .......... <br /> Subdivision ,,,,,,,.,. Seepage Trench .......... <br /> .......................................I............ Privy <br /> Camping Unit ' <br /> Seepage Bed <br /> Locationof ------------------------- ----_—_--_----------------- .�J, . <br /> proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road Q�� i <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 /> yy�� <br /> 5. Lot Size: '��11{� ) /_ Fig. A. 6. Location: GOet✓� ��"�` d�l� - _,, <br /> ft.ufo?,, ft. —oS/,.3...1V...nes q. ft. .�.a'.G..f7en.../ ../T��.AI ,-e0/,-JF A/ <br /> N <br /> m <br /> j O <br /> dG'� 47�ric�jfy� <br /> O <br /> D <br /> Z <br /> O <br /> Y <br /> AJJ to y o <br /> Q � < R = c N <br /> Eno n.� _ � aF <br /> o <br /> NJ <: m <br /> m cm <br /> Z o o n 31 <br /> P �� 0- 3 <br /> �•o � 1 <br /> ... ...... la�/�� <br /> D m <br /> ignatu //O��wner or Agent L� Da p <br /> Remars . 4&..... .. ............... .....`f�.,....:3 . .... ...C. :a' .... ................................ x 0 <br /> ........................................................................................................................................................................................ En <br /> .fj\ . <br /> II <br /> ........... .................................. : <br /> Inspection Date ....................................... .. ?.?140�... ........... ................................. : 1 0 $ o' $ o m <br /> m <br /> Zoning Adm istrator ry 888800001:0) <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 />