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Burnett County Office of Zoning Administrator cn 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d' 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H 0 <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. <br /> J Mo a r seA! <br /> .. ...... .. ................................. <br /> e� T ...r..................../✓ ...................................... . C <br /> OWNER (please prix l CONTRACTOR or SURVEYOR or AGENT a - m <br /> ........................................... ............................................................................................ <br /> ADDRESS ADDRESS �•� <br /> ............ <br /> ADDRESS ADDRESS <br /> 6 ....-.'���;3.................................... <br /> R, <br /> PHONE PHONE <br /> ........................................................................................... . . <br /> .......................................................................... 'Wf <br /> PLUMBER WEL. . L DRILLER <br /> .......... <br /> .. . . .................................................................................. A. .DD............................................................................. �. <br /> ADDRESS RESS <br /> � o <br /> ........................................................................................... ..PHONE.......................................................................................... Z D Rt <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: No. Bathrooms :7- •O '� <br /> 2. New Building Details ••• •••• <br /> New Building ...xType of Construction: No. Bedrooms <br /> Addition .......... ......"..4401 ................��..77.......... Septic Tank Size Gals. ..... <br /> Sanitary .......... Size .. .'f...... ft. x ...^t`�..... ft. .......... ! <br /> Pilungt Grading •„••••... Height...$........ Stories ...... ........ 4a. Absorption Field Site: 3 io <br /> Moving .......... Area Soil Type ............................... ..'- E r <br /> Mobile Home .......... ........................................... Slope <br /> o <br /> Priv Pere. Rate ................................... es* <br /> Privy .......... 3. Use (describe exactly, 1 -family , <br /> Well .......... home,garage, motel, etc.) Dry Well .......... ^� <br /> Subdivision .......... d CA,G G�q;4-46` Seepage Trench .......... 1 <br /> .............. . <br /> Camping Unit ,,,,,,,,,, Privy .......... .e 1 <br /> t. ' <br /> ....................................I............... i 'e'. <br /> Seepage Bed .......... <br /> ____ ___________________ ti <br /> 01 <br /> Location of proposed structures and existing structures well, sewage systems, roads, etc., should be sketched in Fig. A. Include road U1 - <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 <br /> `t <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. w p, is, <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. L catio <br /> ..�:?4...... ft. x . iN <br /> Y..... ft. . ....././`..laa. �r AE Ke...zt� �g e �Glesf Qor..r �,,vo C :!•s •` I;'1" <br /> ........... sq.ft. ......Y.................... ....I......K............... ...................... <br /> N O <br /> o <br /> ' F <br /> � t r,atd ��+•.� � s <br /> �f ^ ra�4�r�t _ rR0.1L <br /> ' 0 a <br /> Ma rye r.Z r� •d I >.� <br /> f .v A1'' m� �n <br /> f a <br /> = �o t a i <br /> w v) <br /> 7J N y T m C M <br /> (NIt <: w amm � <br /> N _. m <br /> 0 n m <br /> as a a - 3 <br /> o <br /> .v.. O -z C)-9 f ` 0 <br /> �� m <br /> �le< .................................. . ................... t,, - C <br /> o <br /> Signa a of Owner or Agent Date - <br /> X <br /> Remarks ......................................................................................................................................................................... .� m� <br /> m <br /> en <br /> .......................................................................................................... . . I <br /> . . ........... ....�h 1 <br /> Inspection Date ....................................... .Q!/.7>�:n./....:..... � ? r3' ?�/.................. o T <br /> Zoning Admin' trator <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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />