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(t,-/) C Tr-C'. `. <br /> Burnett County Office of Zoning Administrator o 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3. <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as o :\ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e <br /> Ordinance, Sanitation Code, and with)all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> Gtl ,.j. AR K. .................................... ���1�z��. :...J.�uti on/............................ N <br /> S <br /> OWN R (please print) CONrf{ACTOR or WRVEYOR or AGENT I1................................. . �..�..C° :..7..a w/:...........s..yoy........ <br /> AD ESS ADDRESS <br /> .. .... 'la, �.....Sy..c.a...y. ................................................................................ <br /> ADDRESS ADDRESS <br /> ............................................................................................ <br /> PHONE PHONE <br /> ........................................................................................... ' <br /> PLUMBER ............................................................................................ .O <br /> WELL DRILLER <br /> ADDRESS .ADDRESS.......................................................................................... : _ <br /> K o i <br /> PHONE PHONE H <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ........•. <br /> New BuildingNo. Bedrooms o <br /> Type of Construction: <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary ......•••. Size ft. x ft. ••.••..... i <br /> Rilling)Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r <br /> Mobile Home .......... ........................................... Slope <br /> .......................................... O <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well „•....... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision .......... Seepage Trench .......... <br /> .................................................... <br /> Camping UnitPrivy.......... .................................................... .......... <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- <br /> so <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 property is located at a highway inter- _Q <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection CLEARLY LABEL EXISTING <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. T. <br /> ____________________ 3 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. xx .............. ft. — .................5.....m...... sq. ft. ............................................................................... <br /> O' <br /> ul <br /> ul <br /> 0 <br /> 0 <br /> r <br /> v <br /> +-' z <br /> ti <br /> n r 9 m so Z <br /> n Q < c m <br /> m a <br /> -o N: m m <br /> z b' na <br /> Him nm �_ <br /> kpEV <br /> _......... . . .. <br /> m <br /> ................................. <br /> ` ivo _ <br /> p <br /> Signature of Owner or Agent Date <br /> .................................................................................................................................................................................. <br /> of <br /> ... . ...K. ............. <br /> T <br /> Inspection Date ....................................... 7Z�. .....Z� m <br /> g J <br /> Zonin Admini trator : 1° 8 8 8 8 8 8 cn <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 />