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6n LC1Yr �F <br /> Burnett County Office of Zoning Administrator iu 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> 3 0 :� <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c V <br /> Ordinance,1Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin_ 3 �a i(A; <br /> OG'Gcf..... ,�.. a��- ar�LJ <br /> :............. .......................................... �� . . . . ..�. . ................................. <br /> ...................... .... .. .E ... ........ . <br /> OWNER (please print) CO TRACTOR or SU RVEV OR or AGENT m <br /> ..3.... ... ..... ........ ... ...... <br /> ADDRESS ADDRESS ., <br /> ........................ 1�eGu�,.... /........55��4 3..................... <br /> ADDRESS ADDRESS <br /> O <br /> .... <br /> . .......................................................................................... <br /> PHONE PHONE <br /> ........................................................................................... .. ........................................................................................ :U <br /> PLUMBER WE.. LL DRILLER S <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS L1 <br /> n O <br /> P..H...O..N..E.. .. ...... . .......... . .. . ... ... ...... . .. . .. . ... .. ... . . . . .. ............. z N.. ... ... ..... ... ...... . ... .... ..... .. ..... .P. O .. ...... . ... .... .... . .. ...... ....... ...... . ..... <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> ' °.'r <br /> i <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> New Building .......... Type of Construction: No. Bedrooms .......... <br /> addition . ........ .................................................... Septic Tank Size Gals. .......... 3 <br /> Sanitary Size ft. X ft. -^ — <br /> ........ .............. .............. <br /> FiuinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r <br /> Mobile Home ........................................... Slope <br /> .......................................... o <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well ...,,,.... home,garage, motel, etc.) Dry Well .......... <br /> SubdivisionSeepage Trench .......... I I i <br /> Camping Unit .......... .................................................... Privy ... <br /> .................................................... ....... <br /> Seepage Bed .......... r <br /> ----------------------------------------------------------- (q <br /> Location of proposed structures and existing structures, well, sewage systems, roads, eta, should be sketched in Fig. A. Include road e <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- I 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. <br /> 0 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> _ P <br /> N <br /> o <br /> - <br /> Zg <br /> Zg <br /> r i <br /> at <br /> I i�y a <br /> Z <br /> I m <br /> t �n <br /> it Lri t1 <br /> 7 r -ov m 2 <br /> M c <br /> n < m c m <br /> o_ a�< <br /> O (I1 < <br /> _. m <br /> z ON n 70 <br /> o a 3 <br /> 0x o <br /> 7- 3 -�5' �� p <br /> ..ner......or.....Agent...e ............................... ..................Date.................... o C <br /> Signature of Ow <br /> ��rr S _ x 70 <br /> Remarks..7.:tk,&"ccd- ../d 3p . �/3 m :(ti mp <br /> ............................................................................................................................................ ro <br /> m : <br /> u ' <br /> .................................................................................I..................... <br /> .. ............................................................................ A <br /> •:'� -n <br /> Inspection Date ....................................... ..�... . . . ... .... �...................... : I�:oo u a o o' N m <br /> 419. .. m <br /> Zoning Administrator iK ✓ . : ° $ 0 0 0 o S co <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 most 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 he revoked if misrepresentation of any of the information conveyed here <br /> with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />