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9-7? C?N; <br /> Burnett County Office of Zoning Administrator per <br /> o� <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 7 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m M <br /> M <br /> Ordinance, Sanitation Cade, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> H <br /> 0 <br /> .Q :f...17.t 4r�.4U. ........... c T <br /> OWN (please printtl-� �. CONTRACTOR or SURVEYOR or AGENT a <br /> OIL <br /> l . .......�"Q�..:3��..................... ..................... ............................................................................................ <br /> ADD S ADDRESS <br /> ..................... _ <br /> 't ........................................................................................... ; CZ <br /> .....{...........7......:ra...4 ......�:a........ >. . .ADDRESS 'rO <br /> ADDRESS <br /> ........................................................................................... <br /> . .......................................................................................... :�Xl <br /> PHONE PHONE <br /> . .......................................................................................... <br /> .... .... - <br /> ................. .. ................................................................ -. <br /> PLUMBER WELL DRILLER ,c <br /> O <br /> .......... <br /> ........................................................................................... . ................................................................................ m G7 <br /> ADDRESS ADDRESS N p �_:-\ <br /> G /V <br /> ................. <br /> . ...................................................................... ... <br /> ........E................................................................ <br /> PHONE PHONz � r <br /> DESCRIPTION 4. Sanitary Facili ' . o <br /> 10 <br /> No. Bath ms .......... <br /> 1. Work: 2. New Building Details L <br /> Ty of Constr ti n: No. B rooms • •• <br /> New Building .. P,g j ? Septi Tank Size Gals. <br /> f .n .......... <br /> Addition ...... ... ° • <br /> /y <br /> / t. x � .^......... .. .......... <br /> Sanitary .......... Size .,��.../.. ft. x ......sf..... ft. <br /> EillinglGrading .......... Height....... .... S--to^^ri��S ...I ..... . 4a. Absorption Field Site: <br /> (.X.� Soil Type .................................... r i <br /> Moving .......... Area ........cff. [................. o <br /> Mobile Home .......... <br /> Slope .......................................... <br /> Privy3. Use (describe exactly, 1 -family Perc. Rate,................................. <br /> .......... Dry W <br /> Well ........., home,garage, tel, etc.) <br /> �a See ge Trench <br /> Subdivision .......... .. . ... q.`: ...... <br /> Privy -�`-- <br /> Seepage Bed— \ <br /> de <br /> Location of proposed structures and existing structures,well, Sewage systems, roads, etc_, should be sketched in Fig. A. Include road ` Zr <br /> a <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. :,U O <br /> __________ ____________________________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: (T '; 2J <br /> ................ ft. x .............. ft. — . . . .......... sq.ft. ............................................................................... i E _:-) <br /> c <br /> N <br /> p <br /> ofT <br /> a <br /> z <br /> x_ <br /> 0 <br /> 30 <br /> d <br /> F <br /> N r y m Z <br /> soa w m <br /> ell <br /> o � m . Dar <br /> Z o0 0 , <br /> o _ n <br /> 0 <br /> o : <br /> :3 I <br /> K ............ <br /> O ; <br /> Signature orbwner or Agent X <br /> Remarks ......................................................................................................................................................................... � I <br /> m <br /> 60 <br /> ........................................................................................................................................................................................ II <br /> ................................................................................I......................... .....................:.'1.........7.. .....,.............. <br /> :/ CZ1lL� <br /> Inspection Date ....................................... ...... �(.L!CT.1f .. ......., f /................ 0 0 0 <br /> Zoning Admi s rator '5. 0 0 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 dny 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 he made without approval of the Zoning Adm imstratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />