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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <br /> TO THF ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < H µ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> C m ?�J <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n 1 <br /> vCI Lco <br /> :I.. ,./.... ................................... .. .................... ..................................................................................... _ <br /> OWNER (please print) , T CONTRACTOR or SURVE VOR or AGENT o. <br /> a..Y....9..�... <br /> ....I..... .... ......�ti..� ..V.........:.. ..:......... : ' <br /> ADDRE S ADDRESS <br /> ....�.. p <br /> ADDRESS / ADDRESS <br /> .......... .........y. . v........ ............................................................ :- <br /> PHONE PHONE <br /> U, <br /> ........................................................................................... .WE....LL DRI. ....'D"iI. .LLER.... ...................................................................... <br /> V <br /> PLUMBER <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS Op o <br /> ............... o <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° .s- <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building .......... Type of ContruriionNo. Bedrooms <br /> Addition /.w <br /> Septic Tank Size Gals. E <br /> Sanitary t�............t. ]....T.�. : <br /> ... .. Size .............. ft. x .............. ft. dO <br /> Rillingl Grading ...... ... Height........... Stories ............... 4a. Absorption Field Site: �- <br /> Moving Soil Type .................................... <br /> .......... Area .................................. <br /> Mobile Home Slope .......................................... W .+ <br /> .......... . <br /> Perc. Rate ................................... <br /> Privy ,......... 3. Use (describe exact) , 1 -family eco. <br /> Well Dry Well <br /> ,......... home,garage, motel, etc. """"'• <br /> Subdivision Seepage Trench .......... <br /> .......... .................................................... <br /> Camping Unit Privy .......... ^'� <br /> .......... .................................................... <br /> Seepage Bed <br /> -- / J• "3/ h ;�— <br /> :y <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be, sketched in Fig. A. Include road p <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- �. $ _o: <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. rsa o' <br /> -------------------------------------------------------------------.-- <br /> i <br /> 5. Lot Size: Fig. A. 6. Location: � ��' a • <br /> U <br /> t <br /> N o <br /> s <br /> U :E rn W 2 <br /> m <br /> z oo na70 <br /> O nom' 3 <br /> y>; o <br /> ....... ... ......4.......... ......................................... ...................................... o c <br /> Signature of Owner Agent Date <br /> -t } X <br /> Remarks .e....... . Z. ..CafZ: G T m <br /> e0.. ' <br /> .............................. ........................................................................................................................................................ — : <br /> L':. . . . . . . T <br /> /y y.............................. <br /> Inspection Date-�.'...3.L`.. 5.............. 0.. ..,,L..�r! 2� ......x,� ......... EIO: N N m <br /> N tl <br /> U N O N O T <br /> Zoning Admi istrator 8 0 8Q8 8 to <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 he 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 /> my 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 />