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Burnett Courtly Office of Zoning Administr for 7 <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 'z0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,� a <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd <br /> reg lations of the State of Wisconsir? a <br /> k14.......\.7,..6.4.K. . ..h...../.'0... ......................... ........................ ...... n <br /> OWN R (plea,;..inti CONTRACTOR or SURVEYOR or AGENT <br /> RA..a..... h. �t .....NA 0 ..................................................................................... ...... <br /> ADDRESS ADDRESS <br /> ....... ...... I a <br /> ADDRESS ADDRESS ° >! <br /> PHONE PHONE <br /> ........................................................................................... 'W"'E...L.L DRILL....R. I'L.....ER.............................................................. ...... <br /> PLUMBER W ;\ <br /> p itJ <br /> ............................................................... ..................................................................................... ...... _. <br /> ADDRESS ADDRESS m 0 or <br /> ........................................................................................... ................................................... ................................ ...... o ;» <br /> PHONE PHONE <br /> Z r its <br /> DESCRIPTION 4. SanitarYFacilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms ... ...... i e <br /> New Building .......... Type of Construction: No. Bedrooms ... ...... i G <br /> AdditionSeptic Tank Size Gals. ... ...... ; <br /> .......... .................................................... <br /> Sanitary .......... Size .............. ft. x .............. ft. ... ...... i i <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ...................... Soil Type ............................ ...... i r <br /> ..................... — iMobile Home Slope..... .... •••••' v a <br /> Privy r,. 3. Use (describe exactly, 1 -family Perc. Rate ........................... ...... i <br /> Well .......... ho rgge, motel,etc.) Dry Well <br /> Subdivision .......... 1 Seepage Trench .. ....... Z i ✓J <br /> .... . .. ... Priv <br /> Camping Unit .......... Y .. ....... <br /> .......... . - <br /> . . .... .. . ........................... <br /> Seepage Bed .... ( <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> IL <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is local d at - <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i }_ -' <br /> ------------------------------------------------------------------- - lr .i o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. - ............................... sq.ft. ...... i iAv' <br /> ...................................................................... . A <br /> ` o [ o <br /> o ' <br /> .1o ' <br /> c , 0 <br /> '1; o <br /> lbor �� }fo s * iia <br /> M .:,) <br /> Z <br /> e <br /> GO 1111 <br /> CIiud0mC <br /> ON G O m m <br /> Z•O : •2 D 1 <br /> 9 �0 . Nn <br /> n o' : O <br /> . . . .../.D��� .p..�......... x �1 G........................ <br /> Date reocanr\ gent <br /> r� O <br /> Remarks ............................................................................... 'P <br /> d N <br /> .... :/..".1.............. ..... e , <br /> ..................................................................................... . <br /> mInspection Date ....................................... ........ .... <br /> Zoning <br /> Istrator 0 0 o g 8 in <br /> NOTE: A preliminary site inspection must be made and a approval granted on all structures involving sanitary fa ilities befor nstruction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation befor 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 pecifications 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 />