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Burnett County Office of Zoning Administrator V 0 0 <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 located as '� � oµ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 ma <br /> .. '.f .l.. ...�` <br /> IV A041-1l? <br /> .......... rG-/ vS N o <br /> T <br /> ............ ............................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m '� m <br /> 5�' /�•S1� ........................ r 2 K'Z'l�s�Y;K LG��S� . i� <br /> ADDRESS.................. ..... . ..... ..... . ..... .. .................................................................................... <br /> ADDRESS <br /> ................. ........ f 1 r�� ..................... .`.f. ' 3............................................. <br /> ADDRESS ADDRESS <br /> PHONE . .........I......................... . . <br /> PHONE <br /> ........................................................................................... .WEL. . ..L..DR....I.. ...R.................................................................... :G1 <br /> PLUMBER LLE.... <br /> ........................................................................................... O \2 <br /> ADDRESS .ADDRESS........FS-S' ............................................................................ <br /> m <br /> n 0 <br /> < <br /> o <br /> PHONE PHONE 0 <br /> DESCRIPTION 4. Sanitary Facilities: o ° .O <br /> o <br /> V V <br /> 1. Work: 2. New Building Details No. Bathrooms .......... �, <br /> o f <br /> New BuildingNo. Bedrooms .......... <br /> Ty of Construction: i <br /> Addition ,•••; rf�',/?h �'-,-/S/ I // Septic Tank Size Gals. .......... <br /> ....... .. .... <br /> Sanitary .......... Size .......2.5/ft. x ........rJ...�f ft. .......... : i .� <br /> Filling/Grading .....•.... Height...�. j.. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area .. Soil TYPe .................................... r <br /> o <br /> Mobile Home .......... Slope .......................................... V • C �* ; <br /> Privy ,,..,,,,,• 3. Use (describe exactly, 1 -family Perc. Rate ................................... tc, <br /> Well .......... home,garage, motel, etc.) Dry Well .,,....... :w <br /> Subdivision ,., j ........., <br /> ..., ..... ... ,F iw <br /> Camping Unit .......... ......... . ...... Privy W i i <br /> .................................................... <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig A. Include road Qt � � <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- fJ4 ;4N _a <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. <br /> ----------------------------------------------------- . ^ <br /> 5. Loss Size: Fig. A. 6. Location: <br /> ....F.B.O.... ft. x .3.71! ... ft. — ...�.��L..CJ....... sq. ft. <br /> N <br /> o <br /> o w <br /> " 0 <br /> o <br /> Z <br /> � o � <br /> 19 o <br /> F <br /> * Np- C� <br /> (Jl < <br /> m <br /> Z OO <br /> D nj 31 <br /> '.f' o <br /> 8- fG/........... ..../..................................... ...................... . ... ..... 4 <br /> g ature of O er or Agent Date/ <br /> X <br /> m <br /> s Lw a <br /> .............................................................................. R �o ................ :� . . . . . . <br /> m <br /> Inspection Date ....................................... .ll .i2Gt... .: i .... ......................... <br /> . <br /> m <br /> 4 Zoning Admi Istrator F J $ $ $ $ $ $ !n <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 />