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-� <br /> ON COMPUTER/SCANNED Cil Con-) <br /> nett County Office W Zoning Administrator d 7 -- 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> fC 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 <br /> Ordinance, Sanitationnn Code, and with ail other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> e.n............. .......r.....a........................................ .. ... ..................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT M <br /> .t.........1. <br /> ADDRESS ADDRESS .+ <br /> ............................................................................... m <br /> ADDRESS ADDRE 5 _ <br /> ........................................................................................... —....... <br /> PHO PHONE <br /> .... ...F...l.d. .1.1.. .,f.................................................. ........................ � t i�Yg <br /> P .................................................................... ,nor <br /> PLUMBER / WELL DRILLER ° h <br /> ADDRESS ADDRESS ? <br /> n <br /> o........................................................................................... ..PHONE.......................................................................................... o .: <br /> PHONE Z h <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building �/ No. Bedrooms '� <br /> /- Type of ` stru tion: ? m <br /> Addition ..,.,, +n"C ,,,,,, Septic Tank Size Gals. <br /> �.�.... <br /> Sanitary ..��..,,.. Size .. .... ... ft. x ..... ... ft. /' i V 1 <br /> Filling/Grading .......... Height... Stories �........... 4a. Absorption Field Site: <br /> Moving .......... Area .......... .�.U........... Soil Type .................................... <br /> v <br /> r <br /> Mobile Home Slope . ........................................ °» <br /> i <br /> 3 <br /> Priv Perc. Rate ................................... <br /> Privy 3. Use (describe exactly famil <br /> Well .'X... home,garage, motel, a Dry Well .......... y <br /> Subdivision .......... Seepage Trench .......... tai <br /> .................................................... <br /> Camping Unit .......... ...........I............................ g <br /> -------------------------------------------------- Seepage Bed------- Id,J-- r :^ <br /> :jw 'iLocation 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 inter- N : C- <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. vit <br /> __--------------------------------------------------------------------- r <br /> O "\ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............._................ sq. ft. .G'.4..v1....h.a..f....`........S-'� ...... Z..'.�.........�U p TE <br /> �/j/e _�1+- <br /> V <br /> N 0 o <br /> : 1 <br /> o <br /> II <br /> f ,-`ItrG <br /> ' G J N_ 'J C N <br /> a _ f <br /> m <br /> o n <br /> I ' Jell3 f o 0o n <br /> m <br /> _r <br /> v/ p <br /> _ <br /> o C <br /> yr -of Owner or Agent Date <br /> Remarks .._ �­X.��........................................................................................._.................._..... m ' . . . n <br /> ..................... .............................................. .................................................................................................. <br /> \ — <br /> ................ �Z. zt ................... .. .................. . _ <br /> II <br /> .1 <br /> Inspection Date ./-.......'�':....w......... (�yi�j2...... . , try/ ............................. ii i U VnZonin dministratorNOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary f I <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 conveyer) 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 />