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3urnett County Office of Zoning Administrator v 0 0 <br /> • n APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT v' 3. _ <br /> O <br /> 10 THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c �1 <br /> )rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a j,'• 0 <br /> d Z 0 <br /> ..e I.v..t\ V ir 1.li'•I''' ' n' ' <br /> DWNER (please 0-int) CONTRACTOR or SURVEYOR or AGENT Q rl <br /> ,��:.6 `a 7F r 1, pit-1" S r, <br /> a <br /> or .74'''', <br /> ADDRESS ADDRESS <br /> co <br /> ADDRESS � � � Q� � ADDRESS Z <br /> �01 SJ „ <br /> 'H PHONE .) \� <br /> K, J lh .. <br /> LUMBER WELL DRILLER 4 <br /> 1 0 <br /> A <br /> ADDRESS ADDRESS =Q 2, o .... <br /> 4 o ; <br /> 'HONE PHONE Z N r '3 i <br /> DESCRIPTION 4. Sanitary Facilities: • o ° „4 <br /> 1. Work: 2. New Building Details No. Bathrooms u o <br /> New Building Type of Constru,Sion: No. Bedrooms ..c9— U o <br /> Addition P--G• �•• $;•/•, -y Septic Tank Size Gals. .7 3- <br /> U u <br /> Sanitary ..)( Size ft. x J ft. <br /> Filling Height Stories 4a. Absorption Field Site: C r <br /> Moving Area Soil Typeu <br /> Grading Slope .\V - <br /> 1. <br /> - <br /> Mobile Home 3. Use (describe exactly, family ) Perc. Rate <br /> Privy home,garage, motel, etc.) Dry Well il- <br /> Well Seepage Trench <br /> Subdivision Privy <br /> Seepage Bed 1..VP y rc ......., <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road IJJo' <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. ` A r o_. <br /> 5. Lot Size: Fig. A. 6. Location: Li <br /> (�, I <br /> ft. x ft. — sq. ft. <br /> m <br /> CD <br /> N o <br /> 7O 7 <br /> ' :�, <br /> o k! <br /> N <br /> rf <br /> •O <br /> 0 <br /> N <br /> S <br /> z <br /> 0 <br /> xry <br /> 0 <br /> m <br /> IA r<j--'"S ..,.. <br /> CD ori * toz <br /> C 0) C CD <br /> CD, NQa< h' ° c <br /> �--� o N fn m <br /> z o0 : a 70 <br /> o 0 <br /> g <br /> � <br /> ol <br /> � o <br /> CA -a ITI <br /> — <br /> Signature of 0�ner o 'gent 7 ' Date o• X M <br /> Remarks .,,,-!.. i.. 0' 4e /7c�.e3 -n m <br /> �riaa c c - .� �1trr r • - . 0 <br /> ii . � <br /> � �� • <br /> .. <br /> G O ANTI <br /> Inspection Date ..%.:..�. i-V wZ9"'�= .4r1% - 0 0 0 o cs, m <br /> rn <br /> Zoning Adminis rator CJ % o o o • o o Ci) <br /> JOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> ,efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig 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 />