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Burnett County Office of Zoning Administrator in 0 0 <br /> APPLII{?ATION 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 located as rn o :� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c i"'Q <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin, 3 a <br /> 4�.. .+..�..(�. ......... ..... "qq..d ^...................... ............................................................................................ y <br /> OWNER (pleas//e�-Intl / C1 CONTRACTOR or SURVEYOR or AGENT <br /> ...I...T.....Q.Q..!1..W.z c.d....... .!.:1.!..`.f............................ ....................................................,...................................... 'a ' <br /> ADDRESS ADDRESS <br /> .W...:S }...'"..r.(.S'..!:.!.U.1!1..... .. ................................ <br /> ADDRESSV ADDRESS............................................................................ K <br /> ................................n........................................................... <br /> PHON. .......4 ....................................... PHONE :T :t. <br /> PLUM ER WELL DRILLER iG� iC <br /> ........................................................................................... . ...... . . ............................................................................... <br /> ADDRESS ADDRESS 3 <br /> 0 o L'. <br /> (� c. <br /> . .... . . <br /> PHONE PHONE � 'S <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> :Ut 0 <br /> 2. New Building Details ���������� d <br /> New Building .......... Type oLQonstruction: No. Bedrooms .......... <br /> Addition . ......... ... .. Septic Tank Size Gals. <br /> Sanitary lcaZ.�?:..`-r v i <br /> .X.... Size .............. ft. x .............. ft. <br /> Filling ,.,.,,..,, Height............. Stories ............... 4a. Absorption Field Site: C <br /> Moving .......... Area ........................................... Soil Type .................................... :Co <br /> Grading .......... Slope .............................. ........... 1 E <br /> Mobile Home .......... 3. Use (describe exactly, ` fam.Iv> Perc. Rate ................................... / E� <br /> Privy .......... home,garage, motel, etc.) Dry Well .........(�/ y' r, <br /> Well ...,,.... <br /> Subdivision ..,.,.,... ......... <br /> Seepage Trench Pc <br /> n'rA,u�I� �.. +— <br /> .................................................... / �.�. .. <br /> Privy � <br /> . <br /> .................................................... Seepage Bed .......... �. <br /> -- -------------------------------------------------------- <br /> Location 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 <br /> property Is boated at a highway Enter <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. �s :Qj <br /> o' <br /> ---------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: Jyl <br /> J <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... k: ON <br /> A <br /> H <br /> O � J <br /> L] <br /> C <br /> Gr : � <br /> T <br /> � l N <br /> n O <br /> J <br /> m v Z <br /> mala< � J <br /> �E m <br /> Z <br /> o J <br /> ]�V N <br /> Signature of Owner or Agent Date <br /> C s c <br /> X <br /> Remarks 4v . .. ....:�f.../..Q.Y .�i. I m <br /> m . <br /> : o <br /> e» <br /> ......................................................................................................... .. .......................................... : N T <br /> OOO to <br /> ................ <br /> InspectionDate ....................................... .. ...:...... ............... ....,......,K.L .................. 0 0 0 0 0 o m <br /> Zoning Ad Inistrator 0 0 0 0 0 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faculties <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 Adminlstratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />