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1 <br /> Burnett County Office of Zoning Administrator - 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m ;41� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a i� <br /> /Q/r.�.C.e.................. S. or.n... .............. //f�� � ............ ( j/o `\ <br /> OWNS R�Tease print) ' /� /� �' ^� CONTRA TOR or SURV EV OR or ENT a <br /> T/ /N� J i O <br /> a.................. ..... ......N............. ......P.�................... ......................Aox...................�.q................ <br /> ADDRESS r AfDRE S n <br /> 7 f r....... ... 1........ .�..!s.�t..r.... S s:.!!.3 w e (1:�5..�.........x..89 <br /> ....... .s... .. <br /> ADDRESS / ADDRESS ' <br /> •:pal <br /> S66..-....Y. 3.E............................................... <br /> PHONE PHONE <br /> ........................................................................................... .WEL"IF-1-.,... 'R"LlL,E,*R.................................................................... :U <br /> °LUMBER L OR' <br /> .......... <br /> .. . .................................................................................**' 'ADI....ES—S, <br /> ... <br /> O O <br /> ADDRESS ADDRESS m 0 \\\ <br /> ................................ —....................................................... ............................................................................................ o' <br /> PHONE PHONE <br /> Zr <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details """"" <br /> New Building Type of Construction: No. Bedrooms .......... <br /> Addition ..xSeptic Tank Size Gals. .......... <br /> ••• <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... ' <br /> Filling/Grading ,,,,,,•... Height............. Stories ............... 4a. Absorption Field Site: <br /> Type Soil Typ .................................... r i <br /> Moving .......... Area ........................................... So �, ° <br /> Mobile Home . ... Slope .......................................... w 1 .. <br /> Privy .......... 3. Use (describe exactly, 1 -family <br /> Pend, Rate ................................... <br /> Well ,......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... <br /> .......... .................................................... <br /> Camping UnitPrivy .......... W <br /> .......... .................................................... ' <br /> Seepage Bed .......... i E <br /> -- h N <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- E v1 a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING '� n <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Q,� o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... `. <br /> e <br /> (a <br /> o <br /> 14 <br /> o ti <br /> z <br /> Z <br /> or <br /> 0 <br /> PT gfaoy <br /> n <br /> TO <br /> In ` � � 77 � (n r�� �rn m Z <br /> 0 E <br /> xa a •c = n <br /> Cloy I F, C < 8 m m <br /> Z o o' n 77 <br /> n <br /> ETm <br /> . . . .................. ... <br /> Signatureof er gent Date <br /> — <br /> X � <br /> Remarks ... ............. ................................!.�...`..... ....1.✓...t..n...c..l..J...�...........•�..................o.............e....X...t.P...�...c../1. ................. ' <br /> . .... <br /> ... � .....c��...-.....Y!...i.f .......................................... .............. .............................. <br /> m <br /> —b Q Y''1 <br /> ..11..... .....................1."..........4(:.^............ .!/.............................. /.W........ ................... ... .... ............................... . \v T <br /> Inspection Date ....................................... ....... { . .......-....�............. .Nn o to u. m <br /> Zoning Admin' rato�n 8 8 8 8�8 8 rn <br /> NOTE: A preliminary site inspection must be made a 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 />