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Burnett County Office of Zoning Administrator i? iq J <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '2 o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other appli able County Ordinances and the laws and 3 `a :-- <br /> re ulatio of the State of Wiscopsin. <br /> .. ....... 5i-y T........................................ .TYS..... .s I...C..r <br /> ... <br /> ............................... <br /> OWNER (pplea�+prJint) !� CONTRACTOR or SURVEYOR or AGENT e <br /> ............................................................. a . <br /> d <br /> ADDRESS AgDR ESS/ ,(/�.��'/�' ,/,( {�I� '• °� <br /> cM:........sSro.�...................... ..../.We... eb. ......!...:C.::`..............�. !.... .......................... i <br /> ADDRESS ADDRESS <br /> fo%2? `T77 — ©6/8' . . ...... . cA ; � <br /> 'PHONE PHONE A <br /> /`! e�5........�ff�f SP <br /> ............................................ ............................................................................................ <br /> PLUMBE WELL DRILLER <br /> 1�1 ?Sr.t........t vis.........S1......r3.. ........... :J o <br /> . ..... . <br /> ADDRESS ! ADDRESSi n C <br /> � <br /> O� ............................................................................................ 0 <br /> ............................................Y............................................ <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: P o o <br /> 1. Work: No. Bathrooms � <br /> 2. New Building Details "Z' � <br /> New Building No. Bedrooms ....... <br /> Type of Co structio <br /> ........., r1, <br /> Addition ...„••..,,, „ cZ-.---('-7 Septic Tank Si Gals. '7,3� <br /> Sanitary .] ft. �•'r <br /> ..k..... Size ..2.. ...... ft. x .... <br /> ••. 4a. Absorption Field Site: <br /> Filling/Grading .......... Height............. Stories ............... ;— .•��, <br /> Soil Type ............ . i <br /> Moving .......... Area ....................................... .°r. <br /> .... Slope ................1 ( ..... . ....... <br /> Mobile Home .......... _ Y <br /> Privy .......... 3. Use (describe exact) -fami Perc. Rate ....... ........................ <br /> Dry Well ” L•_ <br /> Well .......... home,gars , mo I,etc.) """"" _ <br /> .......... <br /> Subdivision La/•••�vy ,. .�. •. Seepage Trench .......... o :tom <br /> ^.(C ...... ........... <br /> Camping Unit Privy .......... <br /> Seepage Bed -- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. 00 <br /> I j c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :� cr o '- <br /> 9 b <br /> 5. L9t SFig. A. 6. Location: <br /> l..fJ.Sl... ft. x . ft. sq. ft. i <br /> 5o <br /> 0` . <br /> o � <br /> wee 44bqcheo� F <br /> Z <br /> 0 <br /> D <br /> a <br /> n <br /> M <br /> M (D -a r- D tp co -0 <br /> 0 »Q < > > 0E `— m <br /> m Na•c - a aaS <br /> 0 0< d C y > > ; <br /> 0 Ci <br /> ZO � D -4 <br /> o T a <br /> Qa o o 9 <br /> m <br /> o - <br /> ....................... ........................... ....5........."".. ..../....... = K p : m <br /> Sig ature of Ow//n/er or Agent Date : o <br /> Remarks . ..1.4. 4 7i'�iy' m . c . <br /> o . o <br /> ...............................7...-....r....y....-...�....�............................. ................0../� P .... ......................... <br /> Inspection Date .......... ........................... ......... <br /> � <br /> Zoning Admin stratd(" ' $ g <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />