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Burnett County Office of Zoning Administrator e 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3, <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 a ' <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> Et <br /> :a <br /> u O <br /> -� <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> ADD ESS ADDRESS '1 <br /> .... IES ........................�............ .............. G/. ..... ............................................................................................ [�v <br /> ADDRES ADDRESS �0 <br /> .................................:...... ... ���............................. ............................................................................................ <br /> PHONE KPHONE <br /> Ij-leO <br /> PFI i r . ...... . .. . ....................................................................... <br /> ... .......................... ......... ................................................ <br /> PL MBE ./ J. ............................ WELL DRILLER <br /> I�^! i <br /> ..�\ ES <br /> ADDRESS ...... ADDRESS a <br /> .................gfQ.G -.wed.. ........................................ ............................................................................................ a <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ' ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ... n 9 o <br /> New Building .......... Typ�e ofL Cogstruc y'�-• No. Bedrooms <br /> /1(QlJF (� f.t. "' Sept'c T k Size Gals. ..... <br /> Addition .......... . . .. ..... ..... <br /> Sanitary ...�... Size .............. ft. x .............. ft. i, <br /> Height............. Stories ............... 4a. Absorption�'Fl <br /> Filling/Grading .......... <br /> 'b <br /> n i OQ1� <br /> Moving .......... Area ......... Soil Type A: <br /> ..../ : .............Mobile Home Slope ...... i o <br /> .......... <br /> i <br /> Privy .......... 3. Use (describe exactl -famil Perc. Rate ................................... <br /> Well ...I...... �,garage, motel, etc. Dry Well .......... W <br /> Subdivision Seepage Trench .......... w ' <br /> .......... .................................................... Privw <br /> Camping Unit y .......... <br /> .......... .................................................... ' <br /> Seepage Bed .......... ? <br /> ---------------------------------------------------------------------- O !Cr to <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road piy a flw <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- _ •���r 11 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING �g ,<-„ u <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O � O <br /> —__ -------------------- --- C <br /> 5. Lot Size: Fig. A. 6. Location: Q+ :f1 <br /> ...0 .: :�. ft. x .... ft. . sq.ft. ` ../............................................................................ <br /> SP E' <br /> 47772"C <br /> c�rQ��,wys o <br /> E r <br /> Zj <br /> W 0 <br /> 'vq�Tl! o <br /> S � <br /> 7' <br /> m <br /> 0 i <br /> 77 to r v 00 2 <br /> c d w c m <br /> y3aa < m E <br /> a Ul < C <br /> m m <br /> Z o o D n <br /> ............................................. ..{ -.................... ...�s......:30...6..b.......... iV o C <br /> Signature of Owner or Agent Date x <br /> Remarks . w ` m <br /> ............................................................................................................................................... m <br /> ......................................................................................................... ...... ..................... 9 ........... <br /> ... .... <br /> InspectionDate ... ................................ .... .... ..... ........... ...... ............ m <br /> Zonin dministrator: E 8 8 8 8 8 8 Vf <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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />