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--CS? 7-7 <br /> Burnett Ccunty / Office of Zoning Administrator Z' --i 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> d r <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c :� <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a V <br /> �...{.......1s.P. ..............................................r..... ............................................................................................ a co <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> ADDRESS asp �! ADDRESS <br /> .......... <br /> ADDRESS ADDRESS <br /> .............. ............................................. ............................. ............................................................................................ <br /> PHONE �, PHONE <br /> V.......... . ....................q.Y�A............... ............................................................................................ <br /> PLUMBER �. r WELL DRILLER <br /> y13...5' r/s, <br /> ADDRESS S^y d 0 1 ADDRESS ;(�1 <br /> O <br /> < <br /> .................................................. . <br /> ............................ .............................................................................. O .i <br /> .. . <br /> PHONE PHONE........ .. z H ' <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: r ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building „•....... Type of Construction: No. Bedrooms ..../... � m <br /> Addition Septic Tank Size Gals. :� � q:r <br /> Sanitary ........... Size .............. ft. x .............. ft. .......... <br /> Filling ••••„••„ Height............. Stories ............... <br /> 4a. Absorption Field Site: i <br /> Moving .......... Area ........................................... Soil Type .................................... ,.) : -)6 r <br /> Grading Slope ............I .. .0................. (� i ° i <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate .....-1.......................... <br /> Privy •......... home,garage, motel, etc.) Dry Well .......... <br /> Well .......... Seepage Trench .......... i '• <br /> .................................................... <br /> Subdivision Privy .......... 1 <br /> .................................................... <br /> -------------------------------------------------- Seepage Bed------------ V :C'J <br /> Cn <br /> c <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road \ (Z� <br /> CT <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ty o- <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. <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. 6. Location 'a <br /> ................ ft. x .............. ft. - ............................... sq.ft.t. . . . ................................................................. <br /> m <br /> Ez � <br /> N O' <br /> O <br /> � 2W1 <br /> rn' ;O <br /> O <br /> Z <br /> :�. <br /> o <br /> o, <br /> m <br /> i� <br /> � <br /> cd z <br /> m m <br /> T NCC.<< - -3' <br /> : * m <br /> /jJD�G �3 `�-•13 a G..11 tK Asa wve l( o01 <br /> 3 <br /> ry <br /> ..... .... — <br /> . .. . ..... . <br /> Signature o Owner or Agent Date ° C <br /> Remarks ... ............r.�k. .�................................................................................................................................................. 'n i E i E i E v <br /> m <br /> .... ................... :..................................................... ..... � ; �-n <br /> c -� E'oE 00000aNim <br /> Inspection Date .Q..................................... .. ................ ....:...9................. <br /> Zonin Adminis for 0 00 0 0 0 ti <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 />