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Burnett County. Office of Zoning Administrator vc o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as ; » <br /> u <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 M :t_, <br /> l "c2N.s,G.....L-......... .N... .o.. ................... ........................................................................ - <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> ..S.t.../4..f....3.........d3.o..x.....I .................................. . . . . ................................................................................... E: u <br /> ADDRESS / ADDRESS <br /> Qac.r!.li.Vn. ............ rl...........:5 .`lk3d............ ............................................................................................ <br /> y <br /> ADDRESS ADDRESS <br /> 6..5�..-..3.. ..Ts.—.................................................. . . ........................................................................................ F <br /> PHONE PHONE <br /> ........................................................................................... . .......... .... .. ................................................................... <br /> PLUMBER WE.. LL DRI.. LLER.. .. <br /> ........................................................................................... .AD.. ... ..RES"'E'S".............................................................................. J <br /> ADDRESS DS m0 <br /> » <br /> n O <br /> ............... . ...................................................................... ............................................................................................ O .+ <br /> PHONE PHONE Z � <br /> °DESCRIPTION 4. Sanitary Facilities: . H r <br /> o <br /> 1. Work: No. Bathrooms 'O <br /> 2. New Building Details '•••••••• o <br /> New BuildingNo. Bedrooms <br /> .. Type of C str ction: •J;�� $ ;Z <br /> Addition •,-,,,.,., ,Qtr, , Septic Tank Size Gals. .... A <br /> ....(<U. . .... ..R. S4M..-.�............. . . < <br /> Sanitary .......... Size ....Tz�...... ft. x ..(a. .... ft. .... ..... :a <br /> i W <br /> Filling/Grading )ties 4a. Absorption Field Site: <br /> .......... . ........... o ' <br /> :k <br /> Moving l <br /> Soil Type .................................... <br /> .......... Area lr3�.....5................... r i <br /> Mobile Home Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> so <br /> Well .......... home,garage, motel etc.) Dry ' <br /> Well .......... � <br /> Subdivision ,,,•„•„• // Seepage Trench .......... o <br /> �-.. .m.t...yl...../�a.m ....... <br /> Camping Unit ......•••• / Privy .......... N <br /> ........................I........................... <br /> ------------------------- i <br /> - -------------------- Seepage Bed 14 <br /> ---- O N <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road o 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- _a <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. a <br /> --- ---------------------------------- ------------------------------- i <br /> 5. Lot Size: Fig. A. 6. Location: m <br /> y6.4...... ft. x .y44.. ft. — ....>�.�...4.4,II.S,$....... sq.ft. ............................................................................... 1 <br /> P <br /> n' <br /> IN O <br /> O <br /> O <br /> �oil s <br /> Z <br /> s�o s �� <br /> E�m <br /> P <br /> \/t R ” <br /> li0/ 7r 1 � c w�: � �m m2 <br /> � c m <br /> Q I Co 6 <br /> C <br /> on <br /> irk <br /> : � m <br /> \ C� Z o o a, D a m <br /> sr-, .- .—.....3..-..g G - <br /> m <br /> ................ .. . o . . . . . . C <br /> ignature of Owner or Agent Date x <br /> Remarks .............................................................4 . ......... ............................................................................... <br /> .. ..L4a.. ...r..................... _ <br /> 93 <br /> ............/7146.. e..... ome......7�......bQ.....r..e.. a� . .. . ..r:...�:v,�F... cs .. t.I <br /> ................ <br /> Inspection Date .................... .................. ..... 2//� s/ .....�.... ... `. ..... m <br /> Zoning Administrator 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 />