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Burnett County Office of Zoning Administra ior �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m a• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described knd y� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd <br /> regulations of the State of Wisconsin. <br /> /" U ...... d ul h Keo // <br /> .... ................... ............... . . ...................................................................................... ..... C s <br /> .......... <br /> OWuuNER (please print) N �7/� CONTRACTOR or SURVEYOR or AGENT <br /> ....!.:..(.h CTI FY. ....... ..."..1..........!._^.3 rl. <br /> ... ` i <br /> ADDRESS ADDRESS °Q \ <br /> .... i C <br /> ADDRESS ADDRESS ,n'.. <br /> t f) <br /> PHO E................................................................................ .PHONE....................................................................... ... 7� + <br /> i'li <br /> ............................................... ............................................................................................ f i� <br /> PLUMBER WELL DRILLER i IN <br /> ..... . . . ............................................................................... S ..... O <br /> ADDRESS ADDRESn O <br /> w � <br /> N <br /> ........................................................................................... . ............................................................................ ...... <br /> PHONE PHON........E Z J r � <br /> DESCRIPTION 4. Sanitary Facilities: f P o » is <br /> "' <br /> h <br /> Batrooms v <br /> 1. Work: 2. New Building Details No. <br /> New BuildingNo. Bedrooms <br /> ..x..... Type of Construction: ��� ��•••• ' � i �T <br /> �rQ-a,.-C Septic Tank Size Gals. i <br /> Addition .... .............. ...................... <br /> .. . ........... .� ..� <br /> Sanitary x Size ....a..Ci.... ft. x ...X!q.... ft. ... ...... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> MMoven Soil Type ............................. ...... 1 •'r�, r i <br /> oving .......... Area ........................... ............. o <br /> Mobile Home Slope ................................... ...... 1 �+ <br /> .......... <br /> Privy .......... 3. Use (describe exactly, -family Perc. Rate ............................ ...... <br /> Dry well ... E <br /> SubWel .......... home,garage, motel,etc. Seepage Trench ... o <br /> Subdivision "' <br /> O <br /> Camping Unit .......... .................................................... Privy .. .LO: <br /> Seepage Bed /.. X;v . 1 ., . <br /> p ,r <br /> ------------------------- -------------- — .S .t r N i"I <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. .j i° C <br /> FL <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located atT <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. \ <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. n <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ....................................................................... ....... i P <br /> C `iL SC <br /> r <br /> N s O <br /> o y J <br /> J <br /> O <br /> 6C <br /> f o <br /> [7 j <br /> /- Z <br /> Z ' <br /> O <br /> S <br /> W <br /> b J <br /> nfAa < - J n - - m <br /> m P:z - o• o n a y <br /> oo< ; � Cy JJ3 <br /> ON <br /> on b <br /> O H OG D -I <br /> nn��NJ � Nd 3I <br /> OJ : fJ <br /> .. .......... ....................................................... ...................................... - X A M <br /> C <br /> Signature o Owner or Agent Date $ <br /> T H <br /> Remarks n <br /> v <br /> ............................................................................................................ ..... ................. .. ....... .......................... .... <br /> . 8 : 8 <br /> rA n <br /> ^ i ... N§ NooNm <br /> InspectionDate ....................................... ..... .. .......... .. ...-Zoning ......... ... ................. . m <br /> Admi istrator 8 8 8 8 8 8 m <br /> NOTE: A preliminary site inspection must be made and site royal granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appi cation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or pecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />