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Burnett County Office of Zoning Administrator d o -- 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT2�1 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m ? ks <br /> Ordinance, Sanitation Code, and with <br /> 7all <br /> loother applicable County Ordinances and the laws and regulations of the State of Wisconsin. a ;� <br /> DY�Q4nin l/f1/Grl.... <br /> � N <br /> ................. ............................................................................................ C <br /> OWNER (please print) CONTRACTOR r SURVEYOR or AGENT 0 <br /> E.........Ca .9 rPss............................. � <br /> ADDRESS ADDRESS <br /> ,. r` <br /> r.�...... .!..... .....m..n... .........s...s�0 ..... ... ...... ............................ .............. . - <br /> ADDRESS ADDRESS ;T- <br /> ........................................................................................... ............................... ......... ............................................ <br /> ...... ~ <br /> PHONE PHONE `S <br /> WELL DRI <br /> N.. .�5..........�C. .........P� ................................ ..................LE...... ..................... ............................................ <br /> PLUM�BE/R//(/r� L <br /> .......✓ (.St..'..!.�.. . ..r.. .......v...'... . ............ .... .................. .. ... ............ � <br /> ............................................ . ............... .................... . ........................................ <br /> ADDRESS ' <br /> ADORES <br /> ' 10�& likal mo .�r± <br /> ........... ... ..... . . . .... ..... .... . .. .... ....... ..... . .... <br /> PHONE PHONE z °oDESCRIPTION 4. Sanitary Facilities: R <br /> It. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building ........., Type of Construction: No. Bedrooms <br /> 77 <br /> Septic Tank Size Gals. � <br /> Addition .......... .................................................... Sep <br /> Sanitary .. ... Size .............. ft. x .............. ft. .......... ^'CJ <br /> Height............. Stories ............... 4a. Absorption Field Site <br /> Filling/Grading .,,, <br /> Moving .......... Area ........................... ...... Soil Type ...C... ............... . <br /> ro <br /> Mobile Nome Slope .ate ..'^.7 <br /> Privy 3. U describe exact) , 7 -family Perc. Rate .....i..T.�.�.�............. <br /> .......... <br /> Well .......... orrte garage, motel, etc. Dry Well .......... <br /> Subdivision Seepage Trench .......... <br /> .. .................................................... c <br /> Camping Unit Privy .......... <br /> Seepage Bed .......... :per <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be, sketched in Fig. A. Include road to Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- t a . <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 'G <br /> STRUCTUHES AND PHOPOSED STRUCTURES AND ADDITIONS. In1 <br /> P-1 <br /> __________________-______________________..__ <br /> 5. Lot Size: Fig. A. 6. Location: O (� <br /> ft. x .............. ft. . ......._...................... sq. ft. ............................................................................... ed <br /> •, i i i <br /> SS <br /> N O. <br /> O J <br /> m O ' <br /> VV �Tj <br /> J 0 <br /> S <br /> T <br /> N <br /> Z <br /> DaO <br /> N <br /> or, T m Z <br /> c d d e m <br /> mor,o a �_ a F <br /> on -. C: N W <br /> O U < to <br /> _. m <br /> z oo aa7B <br /> O > a m <br /> .. ........ ......... ............... ........... ....�.....jc—..�.5... to <br /> Signa re of Owner or Agen Date — <br /> X 31 <br /> Remarks -rt ` m <br /> m <br /> v <br /> ........................................................................................................... ... .............. . ...........`....................................... II <br /> N N N m <br /> Inspection Date .............. . ...................... : '): u, u, b o m <br /> Zon Administrator :I O: $ $ o 8 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 attacher) to <br /> this application before a permit will be issued. Do not purchase or Install a septic tank, do any plumhing or start any build- <br /> ing until a permit has been issued. A permit may he revoked if misrepresentation of any of the information conveyed here <br /> with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />