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Burnett County Office of Zoning Administrator SG' -0 <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. <br /> Ow R (please print " ' CONTRACTOR or SURVEYOR or AGENT <br /> Z?.h....�.lY. J�..�..:........... .......... &..!1.. �. ................. a \ <br /> ADDRESS ADDRESS <br /> ADDRESS ADDRESS <br /> s�6.Q4.......k/Y...... ....,1rl.l. �f............. ............................................................................................ <br /> PHONE PHONE <br /> lQ/ 73' ...if...11.. <br /> PLUMBER WELL DRILLER `h <br /> ................ ............................................................................................ 0 <br /> ADDRESS r ADDRESS n C <br /> o• <br /> PHONE6e� `���� PHONE Z r <br /> DESCRIPTION / 4. Sanitary Facilities: P o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details / ct <br /> New Building Type of Construction: No. Bedrooms ... <br /> Addition Sep�ik��i ze Gals. to c OQ ✓" `}.f <br /> .......... 4 <br /> Sanitary , Size ft. x ft. i.� <br /> Filling/Grading Height Stories a. Absor do ield Site: <br /> o <br /> Moving Soil Type .................................... r— <br /> Areal......................Y./...:........Y <br /> Mobile Home Slope + <br /> Privy 3. Use describe exact) 1 famil Perc. Rate .................................. i� <br /> 0 <br /> Well .......... home,garage, motel, etc.) Dry Well fi <br /> Subdivision Seepage Trench <br /> Privy �U <br /> CampingUnit ........•. ; <br /> Seepage Bed <br /> ---------------------------------------------------------------------- i <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at t� <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I 0' <br /> ---------------------------------------------------------------------- O� <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. .................................. <br /> o n� <br /> �F <br /> M <br /> 4 <br /> o <br /> 7 <br /> NA <br /> M W -0 (nr > ca00 <br /> o a- :' n 03 0 � �- m <br /> m �a — acn aa � <br /> N 7 7 $ <br /> Z 6 O co_ : `G Cn 0 (7 f0 <br /> O 0 K D <br /> cn 7 cn a <br /> r�o a <br /> m <br /> fJ <br /> Signa of Owner or Agent Date o <br /> o . <br /> T 0 <br /> Remarks : <br /> � .. <br /> �• o <br /> o 6 <br /> ........................................................................................................................fonall <br /> ... .. t.. ...... o . <br /> 1 <br /> 69 n <br /> Inspection Date ....................................... u....f .. .. .............. o o cNn m <br /> ing Adfninistrator o 0 0 0 0 o N <br /> NOTE: A preliminary site inspection must be made and site approval grantetructures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />