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Burnett County Office of Zoning Administrator v -. 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 5 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use - C <br /> Ordinance, Sanitation Code, and <br /> .... .He................. N.....fitw..... l other applicable County O�rd/j))n�e�s`and the laws and regulations of the Ste of Wisconsin. = a�� ....... .................. N I a�� <br /> 7 N o0 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> m N <br /> I.b..L.... <br /> ........ya. l!! ... F ✓ 1.E��....lJ.g.!f. ................................................ a <br /> ADDRESS ADDRESS °1 �' <br /> F��.�. -Ey.........m N........55. a.�...................... <br /> ........................................................................................ ti <br /> ADDRESS ,r- f ADDRESS <br /> -J \� <br /> U..'1.3�................................................ ... ........................................................................................ <br /> PHONE ....................................................... PHONE <br /> .................................... . . . ..................................................................................... <br /> PLUMBER WELL DRILLER 3 <br /> o a <br /> ............... ...... .... ........ ..... ................................. .ADDRESS...........SS ...................................................................... .... _. <br /> ADDRESS n o <br /> ........................................................................................... ... ....................................................................................... o' .: <br /> PHONE PHON.. E Z <br /> ix <br /> m .ni <br /> DESCRIPTION 4. Sanitary Facilities: o ° `r <br /> 1. Work: 2. New Building Details No. Bathroomso <br /> .......... <br /> New BuildingNo. Bedrooms a <br /> ...!�... Typ Construction: - ,o <br /> Addition >�E Septic Tank Size Gals. .._...... <br /> ............... ...... <br /> Sanitary +7t..�... .......... e i <br /> .......... Size ..t�.�:.... ft. x .............. ft. �3 <br /> Filling/Grading ,,,,,,,,,, Height..... ....... Stories .....�......... 4a. Absorption Field Site: :y <br /> Movie Area / (..� Soil Type .................................... F rT <br /> 9 ....... .. .....A.O.�.••!. y <br /> Mobile Home Slope .......................................... ^ : c <br /> .......... a <br /> Privy Y, Y Pere. Rate ................................... <br /> .......... 3. Use (describe exact) 1 -famil h <br /> Well .......... home,garage, motel, etc.) Dry Well .......... i i <br /> Subdivision P 9 <br /> See a e Trench .......... <br /> Camping Unit .......... / Privy .......... W <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig- A. Include road r <br /> setback, side and back y highway U <br /> yard dimension and location and setback from all bodies of water- It property Is located at a hi hwa Inter- la °- <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 /> iot <br /> 5. Lot Size: Fig. A. 6. Location: ����t. T <br /> _ I p $: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ................................... ...... tA..K. .................. <br /> J � <br /> n <br /> O C. <br /> �skoxJ �� <br /> z <br /> ox <br /> `-- In I <br /> -� <br /> l ; .0 <br /> 0 <br /> 11 1 0- <br /> , <br /> J <br /> 44 MW dmZ <br /> m cefiso <br /> n N. m <br /> O _ <br /> Z O p <br /> orr <br /> O _ 3 <br /> pl <br /> Lt J so m <br /> 5.. 9-P6..... o p <br /> 'nato Owner or t Date X <br /> Remarks ........................................ ................................................................................................................................ m mp <br /> ........................................................................................................................................................................................ Al 11 <br /> � N . m , Nm <br /> C: N T <br /> Inspection Date ....................................... .l�?7> •l OO�__ e: u, u o c>, o v, <br /> Zoning Ad T4 isi trator �✓ 8 5 8 8 8 8 V� <br /> NOTE: A preliminary site inspection must he 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 issuer). 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 Administrate i. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />