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Burnett County Office of Zoning Administrator v - r <br /> � <br /> 0) - o o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as -- y o-' <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> CD <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3- ).1 <br /> r� h ° O <br /> AP/e/4 <br /> iO W—i7 i b� aCi� 84 Doa-S - H <br /> ,z:\ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT I NO <br /> t\ CD <br /> f!QfR � ` <br /> - , f.. - 511J 3ta <br /> ADDRESS�tADDRESS °� n <br /> (epee 1pc- P7Lvf� Jsc'j =° °J <br /> ADDRESS ' ADDRESS <br /> :W t <br /> PHONE PHONE (���N'"' <br /> �� T v b <br /> PLUMBER WELL DRILLER <br /> X7-3 P gi1 ) <br /> ADDRESS <br /> ADDRESS <br /> PHONE PHONE <br /> DESCRIPTION o <br /> 4. Sanitary Facilities: I • o ° <br /> 1. Work: No. Bathrooms �1 <br /> 2. New Building Details <br /> New Building X Type of Construction: No. Bedrooms ...cZ As -°oCD <br /> h� <br /> Addition �t i7 PP• Septic Tank Size Gals. .7,37 J ItMV <br /> Sanitary .X Size ..,Z.! (7. 't '( < <br /> / ft. x -3 .. ft. $� � <br /> Filling Height S' Stori s ...i 4a. Absorption Field Site: <br /> Moving Area / Soil Type �i� .. `4 1— <br /> Grading Slope Vie 1/6" `•' , ° <br /> Mobile Home Perc. Rate <br /> 3. Use (describe exactly,'1 -family 3 <br /> Priv Dry Well �+ <br /> Y hom ,garage, motel, etc.) KI <br /> Well x Seepage Trench % <br /> Subdivision Privy ;N <br /> Seepage Bed /8a-3 1<,. i L\ <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig. A. Include roadcS C- <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- (..A) N •a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 1 \_ <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Ji 6' <br /> 5. Lost Size: // t Fig. A. 6. Location:,`� / ^ k ,� <br /> d�2 ft. x ..1. ft. — sq.ft. dl1T^� Mme` 2- > ' VI eA kt <br /> cc <br /> Ci? <br /> g. <br /> CCD <br /> N 1 <br /> . a H st <br /> u, <br /> . <br /> AA <br /> /� O. <br /> � <br /> A N C, <br /> 56<e 4 % J pmt ' .O <br /> Do <br /> co <br /> CD <br /> (Di? _ cg c� z <br /> o " � = <br /> N Q O_ - <br /> p w ' `G * m <br /> Z O o m m 7/ <br /> o z <br /> /� U1 <br /> rn <br /> 1 tr"1" F„--7-4-#://Ake7,v --/.3---If. , 0 ,L,i) 0 <br /> iigna re of Owner •.,�!1' Date C ° C <br /> k < fs-- X m <br /> Remarks ... T :t4 : m <br /> 2d—ee C ° <br /> CD <br /> �/ o ff3 T <br /> nspection Date t` �/ e. / 9a-,nec. /� 1` 0 0 0 0 0 of m <br /> Zoning Administr for iri C0000ofm/) <br /> OTE: A preliminary site inspection must he made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith 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 />