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Burnett County Office of Zoning Administrator V --I 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 < — 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 [ �J <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> p )7 <br /> .......:.... ............................ &: .. .. .<).. .. ........................................ C <br /> OWN@fi (Please print)... <br /> •"'... . .• . . •........•••...... .• . <br /> •'• '. CONTRACTOR or SURVEYOR or AGENT a :� <br /> ... .y...................................................................... a <br /> ADDRESS ADDRESS <br /> .......................... C,G..�� ..... .: .... ... . .....SiP%3................................... <br /> ADDRESS <br /> ADDRESS i <br /> ........................................................................................... <br /> P <br /> ............................................................................................ <br /> PHONE HONE i� <br /> ........................................................................................... . . . ..L...DRI...........LLER..................................................................... <br /> PLUMBER WEL <br /> ........................................................................................... .AD......DRESS..................................................................................... <br /> � <br /> ADDRESS <br /> o <br /> . . . . ............................. . <br /> PHONE PHONE Z h r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° x� <br /> 1. Work: No. Bathrooms •° y <br /> 2. New Building Details •��•••��•� :p�New auildingNo. Bedrooms ° <br /> .......... Type of Construction: •••••• •• <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary Size ft. x ft. ••.......• <br /> .......... .............. .............. <br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: E <br /> Moving .......... Area ........................................... Soil Type .................................... `: r Mobile HomeSlope .......................................... <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well <br /> We <br /> Well home,garage, motel, etc.) Dry '••••••••• <br /> Ll... <br /> Subdivision Seepage Trench .......... <br /> .................................................... <br /> Camping Unit ,_,,,,,,,, Privy .......... <br /> .................................................... Seepage Bed <br /> .......... <br /> ---- ------------------------------------------- to <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig. A. Include road c: <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. o <br /> ------------------------------------------------------- -------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> e <br /> ° <br /> 336 a 33 7 '� � T' F <br /> ( dl to <br /> z <br /> 'C �v <br /> Qfe She YntA,+s oiii�! De<- 3,d) I q85 <br /> CO�(.t[hew avP rC:..:...i lots a�3, <br /> �Or o� <br /> wed in oat b,z used /4-d- users. <br /> M r- M w m Z <br /> B fNlr `)C c <br /> 0 0°/: am <br /> p <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks . ................................................................................................................................................. � W m <br /> 0 <br /> t» <br /> ............................................................................................................... ............. .. <br /> I4 <br /> ap a „ <br /> Inspection Date ....................................... uN a 0 91 0 N m <br /> ... . ... . . .. ...... y <br /> r/ Zonin Adminis for 8 8 8 8 8 8 y <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 />