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Bu matt County Office of Zoning Administrator u CID 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> 0 <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 m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> �-� D....lt.. . C S //`_- N o <br /> .... fr'5......... ..N..>.............................. ....... . . . ............. . . . ...................................................... a <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> 1 ....... a h <br /> ADDRESS ADDRESS � f <br /> .JoACaifLU.).�iJ�C .............. . <br /> ADDRESS ADDRESS <br /> 41, <br /> . ..................................................... ................................................................................... <br /> PHONE t PHONE y <br /> jo <br /> ///{/��NIBER .°.. .. .....GG7.........5....... ........ .... ................... . ............. . .. ......................................................................... E f <br /> P . . . .. . . WELL DRILLER ;CF <br /> LU <br /> 00 <br /> .......... <br /> ........................................................................................... .................................................................................. . <br /> ADDRESS ADDRESS n O :O <br /> ............. <br /> ........................................................................................... ............................................................................... <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> K 2. New Building Details ""y <br /> New Building {`... Type of Construction: No. Bedrooms .......... (y <br /> Addition 'j sYv.- _ Septic Tank Size Gals. :. <br /> .......... ....... . ......................................... . ?..UVJ <br /> Sanitary .. .... Size .............. ft" <br /> x .............. ft. 7 <br /> Filling/Grading .......... Height.........y. (tortes ............... 4a. Absorption Field Site: <br /> Moving .......... ArSoil Type .................................... r i <br /> o <br /> MobileHome Slope .......................................... i .. <br /> Privy .......... 3. Use (describe exactly(;1 -family Perc. Rate ................................... / J <br /> Dry Well I <br /> Well ...?<... home,garage, motel, e . """"" <br /> SubdivisionSeepage Trench ........., yj i i i <br /> Camping Unit .......... .................................................... Privy ✓_". i <br /> Seepage Bed <br /> ------ ----------------------------- ------------- % m <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched In Fig. A. Include road �I Q <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 /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I o� <br /> ____________________________ z ... s ft. ........ <br /> 5. Lot Size: `-� ---- — ........ r 4 "` <br /> ................ ft. x .............. ft. . ..... .. F'Ig t. 6. Location: . ........ r i i <br /> 9 <br /> NFet <br /> Ft <br /> N O <br /> o � <br /> o <br /> b o <br /> �t <br /> �C <br /> N r M y W 2 <br /> C N N C N <br /> cn < C <br /> m <br /> o E5 y n <br /> 0 o o n <br /> 0 0 am 3 <br /> 11 l �D �7 <br /> ..: :..: .5�^��� ....`, 1nC............� %� �0 p <br /> Signature of Owne�ar Agent Date — <br /> // x v <br /> Remarks ..1.....,. . `'`z. -f;i� ...................................................................................................................... �' i : <br /> <t` �.............. <br /> i <br /> ............... ................ ....... <br /> :0 iin <br /> Inspection Date ............ -... . .�. !. . . . ............�.. ....... .... <br /> .. . .. . ... . . . . . .. ............ ................ . c <br /> Zoning ministrator 8 8 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all Structures Involving sanitary fcl/sties <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 />