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Burlrett County Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> (� v o <br /> ....................... .Prdlll SrR�, <br /> S. .`. N.L..� . , v. ,�I T......... o <br /> OWNER (Please print) CONTRACTOR..or SURVEY'OR or AGENT n <br /> ()y S..Zv......4.Eti'.T..T4( ................................. ............................................................................................ a Z <br /> ADDRESS ADDRESS m 'b <br /> STR.e.y...,.. .mIeN� .........ss9.z9...................... ..W k.SKr:,. .!.............................................. ?� <br /> ADDRESS ADDRESS <br /> 1 <br /> ............................................ ...a�s`1.`..? .5.��........................................................ oc <br /> PHONE PHONE <br /> ........................................................................................... . . . ..................................................................................... <br /> PLUMBER WELL DRILLER {} ' <br /> .. ...................................................................................... <br /> .. D'D"..ES"S' ............................................................................ <br /> 0 9i� <br /> ADDRESS ADDRESS 0 G1 +C <br /> n o <br /> ........................................................................................... ................................................ ..... ..................................... <br /> PHONE PHONE z � r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° .` <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> No. Bedrooms .......... <br /> New Building ...... TY of Construction: ; <br /> Addition ``,, C L Septic Tank Size Gals. .......... <br /> ....F.... ... .�.TP.... ................J................ <br /> Sanitary .......... Size ...IA...... ft. x ..a1..iZ.... ft. .......... <br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area ........................................... Soil Type ....................................Mobile Home Slope .......................................... o 0 <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well .......... h me,garage, motel, etc.) Dry Well .......... U <br /> Subdivision i97 ,y Seepage Trench .......... <br /> t....V...... .2...... .......... <br /> Camping Unit .......... 15 1!✓ �{} /,t/ PfIVY .......... i <br /> E'7 ....1...... .......,. 41................. <br /> Seepage Bed ...I...... <br /> 01 <br /> C \\ <br /> Location of proposed structures and existing structures, well, sewage systems, roads, eta, should be sketched In Fig. A. Include road Cc-- <br /> setback, side and back yard dimension and location and setback from all bodies of water. I1 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. p'�_➢ <br /> --- -------------------- --- — ----------------- <br /> n ( i <br /> 5. Lot Size: Fi9 A. 6. Location: �O <br /> ................ ft. x .............. ft. . ............................... s4.ft. ............................................................................... <br /> N <br /> o <br /> i s <br /> l �d L( 2�1 i� <br /> 'mc c-cil c��� o�L s ( � 6� u 0 <br /> o <br /> So'o �p �n scc�P lLk ^bjl� - <br /> �G <br /> s <br /> m xa <br /> m . m <br /> 0 o o' n 77 <br /> m <br /> m <br /> p <br /> Signat e f Owner or get?S nt Date X <br /> Remarks ......................................................................................................................................................................... m m <br /> O <br /> ............................................................................................................. d <br /> u <br /> Inspection Date ....................................... . . `� �qr� <br /> . . ............... u a o o m <br /> ........ ................. <br /> . <br /> Zoning <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 Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />