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ON COMPUTER/SCANNED --)c2?_e�, ;,_� <br /> Burnett ( .y Office of Zoning Adminisfi'ator iv -,o o <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H o V <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use - cI CD <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a — <br /> r <br /> ho.a�..... .0.E er. .1c�,- - ° <br /> Q <br /> y � : <br /> . ....... .. <br /> OW R lease print) CONTRACTOR or SURV YOR or AGENT a ; <br /> �Q ��, I�.p I, f G/. <br /> �./... ................................................ A.!.�4%.lh�.�?,.....4..�.......... .......l.a1Q5f6............................ d <br /> QJ <br /> AD[ ESS v — <br /> u <br /> ......... .��{.. .g ............... ..................... <br /> ADDRESS ADDR�SS <br /> PHONE.......................................... E ....... <br /> ...................................... PHON. ....... ............ <br /> ........... <br /> ........ <br /> ................................... <br /> ........... ...... ..................................................................... <br /> PLUMBER WELL DR....ILLER.. :C) <br /> :=7 <br /> ......................................................... ...................................................................... 0 ;� <br /> ADDRESS ADDRESS m M <br /> 0 o <br /> '*—' < <br /> ............ <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> .......... <br /> New Building No. Bedrooms o <br /> .......... Type of Construction: ` C <br /> Addition Septic Tank Size Gals. <br /> ........................... <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving Area ............................ Soil Type .................................... : : r Mobile Home Slope .......................................... <br /> .......... <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well ��, home,garage, motel, etc.) Dry Well (}t <br /> Subdivision Seepage Trench .......... <br /> Camping Unit .......... Privy .......... <br /> ..................lf <br /> Seepage Bed .......... <br /> ------ ---------------------------------------------- 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- a <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 /> 0 <br /> ------------- <br /> ------------------------- --------------------------- -- �- <br /> 5. Lot—Size: Fig. A. 6. Location: <br /> . ...... ft. x . ...... ... ft. <br /> — ...!C?5.1 f.��........ sq.ft. ........................................................... .....�....... <br /> m <br /> N o <br /> , o <br /> , <br /> t O <br /> A40ec <br /> rc �r i <br /> ' z :Z <br /> i o : <br /> Co <br /> L <br /> C C 0) CC (D <br /> CD6 7 N <br /> f <br /> ffl a <br /> m 0- a* <br /> a CD <br /> !� O m D a rr <br /> O 0 7 a 7 EA `n S <br /> ( . . . . . <br /> rr <br /> ......... <br /> ....,.....e.............ner......or.....A............................. <br /> igna ....q.-.Lq.-:��o <br /> Stur of Owgent Date , <br /> X . . . . <br /> Rem rrs .............................................. ......... m <br /> CD <br /> .......................................................................................................... .................... ............................................... <br /> Inspection Date ....................................... /n�nG : N N a" N rr <br /> .. .....qa u. li 4j .�/.n. ............ ui cn cn o cn rr <br /> Zoning Admir4�'strator lJ . 00 0 0 o U <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, 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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />