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�J. ytC Z'r'�Pcg <br /> Burnett County Office of Zoning Administrator d 0 0 <br /> J <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> v o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and locatgd as m jn <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land,Use m c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin_ o- <br /> a <br /> ...ti.1..:!...!1..!^..........�,�. .................................... I...... p O <br /> m <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> .................... ..................................................... .. .... <br /> ...� .....Sy.!........ .4..Z �.ry.. ?...u.w�.......... .....................................................................................L...... a <br /> ADDRESS ADDRESS `"'[ <br /> .../4. .:........ ................................................ <br /> ADDRESS ADDRESS ?V i i�1 <br /> ........................................ ........................................................................................... <br /> PH E PHONE <br /> .. <br /> . LIJMB..... ... .......... ........................................... . . . ... . . . . <br /> n V <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS C) K+ <br /> n o <br /> ........................................................................................... ........... y' <br /> PHONE PHONE Z o s� <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details " " !� i <br /> o <br /> New Building ., No. Bedrooms <br /> ........ Type of Consfrue�n, <br /> o� <br /> Addition ,,..,., � ,X{ S.11,/�., Septic Tank Size Gals. <br /> ...... S <br /> Sanitary ,,, Size .............. ft. x ............., ft. '� <br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type ............................:....... <br /> .......... .................................... ...... (^ Q <br /> eo <br /> Mobile Home Slope .......................................... .. <br /> .......... <br /> Privy .......... 3. Use (describe exac y, 1 -family ............................ <br /> See <br /> Well .... ..... home,garage, motel, Dry Well .......... <br /> Subdivision ... ...... ........................... Page Trench ....... <br /> Privy <br /> Camping Unit ......... <br /> .................................................... Seepage Bed lel.`. <br /> Location of proposed structures and existing structures well,sewage systems, roads,etc.,should be sketched in Fig. A. Incl ude 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 a <br /> section, show the interstmirg highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. n 5;-' <br /> ----_-_---------__-.--------------------------------------------------- L <br /> J <br /> 5. Lot Size: Fig. A. 6. Location: ? ?r l) <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... !Q <br /> 0 <br /> N <br /> n <br /> N p <br /> o J <br /> J <br /> O i:Iia <br /> i0 <br /> N 0 <br /> 0 <br /> E <br /> J <br /> a <br /> O � Q <br /> v <br /> J <br /> i n <br /> II <br /> poN 9 < m M Z <br /> < < N <br /> niT � < <br /> 5 Na a.< _ p <br /> m <br /> Z oo n � � <br /> 1 m <br /> a <br /> p <br /> .... .... ... ................................. ...................................... �o . . . � : C <br /> S1 at re of//Own�/e Ag nt Date X <br /> Remarks ..C.. l.`'. .... a....<.. .<. :r.....`.....( - T O <br /> ...................................................................................................... I <br /> n <br /> ..c.............................................................................. ........ Z dministrator.................:.... � . : <br /> l <br /> . . <br /> r �, . CCCCCC T <br /> ..-' �— c� U G O O (T <br /> Inspection Date ..........?'....::j...�.:... .. ............t..... .......................................�,,... x N N m N T <br /> :V: goo 0 V) <br /> NOTE: A preliminary site inspection must be made and site approval granted on all Structures involving sanitary faCIIItwS <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 budd- <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 Ine made without approval of the Zoning Adm 'mistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />