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Burnett County Office of Zoning Administri for �' o <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 i <br /> reulat ns of the State of Wisconsin. a <br /> N.rE ...... .....o .s..x �. O..: ........ ...... r` .N.K...... <br /> 1" .:. .��,yy... . ........................ ...... <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT <br /> ;so <br /> ADDRESS S.Ta..z....RT � •� <br /> a <br /> ADDRESS ADDRESS � <br /> �.o.. ..tt.a. ......�.... !..!.s ..... <br /> ADDRESS � ADDRESS J <br /> ............G.G..L..... .. ..l..v...l........................................ ... . . . . <br /> .......................................................................... ...... <br /> PHONEPHONE <br /> . ............................................................................... <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS C <br /> ........................................................................................... ..P.HONE........................................................................... Z <br /> ...... ....... o <br /> PHONE N r <br /> DESCRIPTION 4. Sanitary Faciliti ° o <br /> 1. Work: No. Bathro s 0 <br /> 2. New Building Details .. •""" c <br /> New Building .,p,,,,,, Typ�g..ppf Construction: No. Be oms .. ....... E <br /> Addition YD t Septic Tank Size Gals. .. ....... <br /> .. ....... ......... �...... <br /> . ..�.... ........ ..F.. .. ....... <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> Filling/Grading ..,,,.,,,. Height........... . Stongs ............... 4a. Absorption Field Site: <br /> Moving I . Soil Type .............. � � r- <br /> Area ........... ....... <br /> Slope ............ .... ............... ....... <br /> 0 <br /> MODIIe Home v <br /> Privy ..•••..... 3. Use (describe exactly, 1 -family Perc. Rate .......................... ....... � J <br /> Well .......... home,garage, motel,etc.) Dry W .. ....... m :� t <br /> Subdivision _ See ge Trench .. ..•.... o .N <br /> .......... ........... ...... <br /> Camping Unit .......... ........................ y .. ....... <br /> P ' <br /> ............................................... .... Seepage Bed <br /> Location of proposed structures and existing structures well sewage systems, roads, etc. should be sketched in Fig. A.at •Q <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is local d l� a <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. o' <br /> __ _---------------------------------- -- <br /> 5. Lot Sim T <br /> r 7 Fig. A. 6. Location: d <br /> 1.�4?....... ft. x. b... ft. — .... — estencV .LKEw 11 ., Jv <br /> ct 1 3 <br /> G.r,Ys IN�F r.-Tr,•�er.., 1-� she. �' �' <br /> O 7 <br /> � y <br /> Q T <br /> n <br /> 0 <br /> T <br /> c <br /> Z <br /> O <br /> N-1 _ � `l"o be- �n 3 -Jw' l— <br /> d <br /> C <br /> M rnvrn r- Dm 1p <br /> agy : � ygm 3 <br /> Z—o ° a <br /> » ° O <br /> �1. - � .... ...........�..,�.. ....1.�..-..�...-.. .�.... o <br /> Signature of Owner or Agent �' `� Date g <br /> Remarks \ T ' y <br /> ................................................................... . <br /> v <br /> N ' O <br /> ....................................................................................................... ...... ....................... .. ...................... O <br /> (//{,(..I I/. .... C� (NT til, Sri O O tl, <br /> Inspection Date ....................................... ..... ... . ........:....... .. a< r/V'/./J'.• Y' <br /> Zoning Administrato C; 8888 <br /> 5 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construct! , <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation 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 beell issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or 3pecitications 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 />