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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <br /> Cl <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinances, Sanitation Code, and with other applicable County Ordinances and <br /> the laws and regulations of the State of Wisconsin. 3 6 <br /> PPl .............. O <br /> 1 h O 'P d C l . ................................................I..... . . <br /> OWNER (please p CONTRACTOR or SURVEYOR or AGENT <br /> �y(y� <br /> ....'.1. .......... ....... ... . ..... ..... ....... .... ...... ......................... . a L <br /> a, <br /> ADDRESS x ADDRESS a, <br /> r y <br /> .. <br /> . . <br /> JD .,ESS LC.. <br /> A ...............�...... ........................................... .ADDDR <br /> -- .......S............................................................................... <br /> D'R ES <br /> ........................ .. ............................................................... <br /> ............................................................................................ <br /> PHO E PHONE ' <br /> kg <br /> ...... . .................................................................. . . ..................................................................................... ?.`\ <br /> PLER WELL DRILLER - I '� <br /> .............. <br /> ......... —........................... .............................................................................. <br /> ADDRESS ADDRESS :�1 � 0 ' <br /> • n O <br /> E D <br /> < <br /> 3 <br /> PHONE PHONZ <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New BuildingNo. Bathrooms "" <br /> Details o d, <br /> New Building .......... Type of Con truction' '/ No. Bedrooms ....c�.- <br /> ' Ti•q/(,.</' Septic Tank Size Gals. ...... ... <br /> Addition ...... ....... 1.�. ..1..... ...... ... <br /> Sanitary ... .. Size .............. ft. x .............. ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Type .................................... <br /> r i <br /> Moving .......... Area ........................................... Soil o <br /> Mobile Home .......... Slope .......................................... <br /> Privy Perc. Rate ................................... <br /> ... 3. Use (describe exactly, 1 -family V <br /> Well ... ,... home,garage, motel, etc.) Dry Well .......... ._ <br /> Seepage Trench .......... '• <br /> --Subdivision .......... <br /> ..11............................................. . y <br /> Camping Unit Privy <br /> .......... .................................................... Seepage Bed <br /> ___________________________________________________________ to <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be. sketched in Fig. A. Include road 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- I �- <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXIST IN n <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 1 0 <br /> ---------- ------------------------------------- -------------------- <br /> 5. Lot Si e: Fig. A. 6. Location: :E <br /> ..�.0 ... ft. x ...y.�..... ft. — '..3. r:ne.f•...... sq. ft. ........................................................................... .J iuo <br /> co <br /> C <br /> 4N : <br /> W" 0 <br /> 111t, S <br /> 9 <br /> o <br /> 'qtr d <br /> s. <br /> gS` — ---- <br /> �-- too <br /> M <br /> Z O on LX <br /> �7 <br /> 0 an,a <br /> J r _ 7141 p <br /> Si use of w o A ent Date ' <br /> j ................................. <br /> . T m <br /> RemarksG ✓.............. . .............................................................................................. <br /> .................................................................................... <br /> ...........I..... ... ..... ........... . . <br /> G <br /> ...............1. c'. ..=.... rXw...1�n .. II <br /> ............................ ...........".. �. . . . <br /> IQN + + N <br /> m <br /> Inspection Date ....................................... ...................... m mnistrator 888N8 y. ...... ............. ...... .... <br /> Zonin <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facllities <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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />