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Burnett County Office of Zoning Admini trator I+ Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ' <br /> 3 <br /> TO THE ZONING ADMINISTRATORThe undersigned hereby makes application for a Permit for the work described and Ic catetl a5 '< � �• <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County and Use e <br /> Ordinance, nitation Code,and with all o r a licable Count Ordinances and the laws and regulations of the State of W sconsin. c- <br /> PP Y g 3 <br /> . ,�2or0(� ,N,�� y <br /> .. ................. . ... . .............................................................................. ........... <br /> OWN Rapleas �'/qtl '/ CONTRACTOR or SURVEYOR or AGENT m <br /> ...c�.7`sr.[. .1 !.I.....E3 o x /`f 7 a �. <br /> ........................ ............................... ................................................................................ ........... <br /> a <br /> ADDRESS ADDRESS • <br /> 12— <br /> .60....e... .-.9...7.....-.. ........ ............................................. <br /> ADDRESS . .............................................................................. ........... <br /> ADDRESS •� ? ; <br /> ................................. .. <br /> ............................. ................... <br /> PHONE ........ . .............................................................................. ........... .—. <br /> PHONE <br /> PA <br /> ........................................................................................... <br /> PLUMBER . .............................................................................. .. <br /> WELL DRILLER ......... <br /> (' <br /> ADDRESS ............................................... <br /> . .............................................................................. ........... <br /> O a <br /> ADDRESS o <br /> . . . . . . .................................................................... . ......................................... ........... o ,`: <br /> .. . .. . ......... . . . HONE.......................... . y <br /> PHONE PHONE _ <br /> DESCRIPTION Z r <br /> 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... ("�it v <br /> New Building . T e No. Bedrooms .......... <br /> ... .. Type of or}struction: <br /> Addition .......... ,,,,•,•,••{��-rA' /e ••••,.• ... •. Septic Tank Size Gals. .......... '• <br /> Sanitary ,,,,,,,,,, Size .d .� ft. x �•••• ft. - ••••...... I i t_ <br /> ............ <br /> Filling/Grading Height/ ....... Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ........................ .........., <br /> Mobile Home Slope ................................. ....... ........... i r» <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ....................... ........... <br /> Well home,g rage, motel, etc,i Dry Well <br /> Subdivision ,,,,,••••• ri Seepage Trench i <br /> --Camping Unit— •• •• ••••••• <br /> .......... ..... ....... Privy <br /> .......... <br /> _______________ Seepage Bed .......... E <br /> Location of proposed structures and existing structures, well, sewagesystems, roatls etc., should be sketched in Fig. A. Incl de road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highw y inter- <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING3j5 <br /> H <br /> _________________________________ i <br /> _--- <br /> 5. Lot e: Fig. A. 6. Location: <br /> x .............. ft. . ............................... <br /> a <br /> N <br /> O <br /> o <br /> v' <br /> Z <br /> O <br /> JJ <br /> O j � <br /> ( e <br /> m <br /> Agam F <br /> 9 fN1t <br /> C : ce <br /> o o <br /> Z 00 <br /> o —= 3 <br /> 49 <br /> Ion <br /> o <br /> t f o <br /> �� is-b'6 <br /> D m <br /> m <br /> p <br /> Si/nliu4,ef Owner or Agent Date C <br /> Remarks .. x <br /> ..... ? m <br /> ....................................................................................................... <br /> v <br /> ...................................................................................................... <br /> II <br /> � ....... ... <br /> Inspection Date ....................................... . ...... .. ... ..... �........n. ... .. ......... <br /> N ' m <br /> Zoning Adm �tao T[ <br /> $ 8 g 8 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures ii,volving sanitary facih <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatior test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any alt robing or start any build <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the in ormation conveyed here <br /> with is found to exist. Changes in plans or specifications shall not fie made without approval oft e Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />