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Burnett County Office of Zoning Administrator 0 --1 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 \. <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 m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a �. (� <br /> h �e7 f3/t�c>l�rsa�►J a <br /> o. 1�1 , .�3.....r................................... ............................. .......... . .... ......................................... _ <br /> 0 NER 1 e e print) I CONTRACTOR or SUR VEV OR or AGENT a <br /> m <br /> ..�..�.. ..... .!( .Cj1.� Vs ...... }l✓, ...` ...........1�1t....c�........... ... . ....a�a��.................... a • <br /> A RESS _ ADDRESS Ell <br /> y <br /> .I.�Q.1 ...A.../� 1.r..n. .r�J.... 5.. .Q.. .......c .s7` r....... <br /> w.'. . -...................... <br /> ADDRESS ADDRESS <br /> .`-.` a..l...S.................................................... ............................................................................................ <br /> PHONE PHONE <br /> ........................................................................................... . . <br /> WELL DRI . .LLE...................................................................... V l <br /> PLUMBER R <br /> p <br /> ADDRESS............................................................................ .ADDRESS............................................................................ » 0 <br /> PHONE PHONE Z H "I <br /> DESCRIPTION 4. Sanitary Facilities: o <br /> 1. Work: 2. New Building Details No. Bathrooms ....... <br /> New Building .,,y.,.. Typ ofCgnstru Ion: No. Bedrooms .......... <br /> ( Septic Tank Size Gals. .......... <br /> ... <br /> Addition ...... .�''.. . ./I. . x........../.'........... < <br /> Sanitary .......... Size ... 7.... ft ....IV.K... ft. .......... <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: i <br /> g Soil Type .................................... _ :� <br /> Movie .......... Area .......................................... <br /> _ o <br /> Mobile Home .......... <br /> Slope .......................................... <br /> Privy .......... 3. Use (de ribe exactly, 1 -family. Perc. Rate ................................... i <br /> Wellhome gara motel,etc.) Dry Well S <br /> .......... <br /> ?� <br /> Subdivision Seepage Trench I <br /> ........ . .................................................... � <br /> Camping Unit ......, ..... Privy .......... <br /> ............................................... Seepage Bed .......... :T <br /> ---------------------------------------------------------------- <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- I a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING `j <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 <br /> -----------------------------------------———————————————— -- -------- <br /> 5. Lot Size: Fig, A. 6. Location: <br /> ................ ft. x .............. ft. — Q....!-d`F:'.%""' sq. ft. ............................................................................... <br /> nl <br /> / ✓ <br /> N � O <br /> usIl 5 1 <br /> a <br /> s <br /> m Yv <br /> 'A14 <br /> �' <br /> Z <br /> oM <br /> iz5 <br /> (1L 37 ca r- M :E w Z <br /> E <br /> o' vNi a a" m m <br /> ZO L 0 a <br /> 0 �;0 <br /> cn i = —i <br /> o <br /> ....,d... ... .......g ...7....... <br /> Si ture offT!ner ory/Apent / Date X <br /> Remarks .,,,J.�R/.,p.'-rl ... �1�.<., <br /> 8 <br /> ........................................................................................................................................................................................ •n <br /> ...................................................................................................... . . .,t/,� . ... <br /> Inspep ..W/fes / / NNPmPN rn <br /> ction Date ....................................... u, v, o U o u, <br /> Zoning Adminis .`............ 8 8 8 8 8 8 y <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, clo 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 />