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' <br /> . , <br /> Burnett County Office of Zoning Administrator w CD 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 7. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H ., <br /> shown herein. The undersigned agrli s that all work shall be done in accordance with the requirements of the Burnett County Land Use CD m L1/4.1Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- IA �t <br /> PNELPS = Q ° <br /> N V <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a 0 CD <br /> C.Tar' Rrt <br /> ADDRESSADDRESS <br /> letri ADDRESS S� S�e r �J ADDRESS <br /> r:PHO ePHONE ~ <br /> H <br /> PLUM ER WELL DRILLER <br /> Q. <br /> ADDRESS ADDRESS "_ <br /> o' . C <br /> PHONE PHONEZ H • <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° ') <br /> 1. Work: No. Bathrooms ill ° <br /> 2. New Building Details o <br /> New Building No. Bedrooms <br /> .... ,,,,. Type of Construction: -FD <br /> Addition F r 4...1.,"—A.... Septic Tank Size Gals. <br /> Sanitary ... ,,, Size AX ft. x 5—.1 ft. 2 '...t) <br /> 1."I..( <br /> • <br /> Filling Height Stories 4a. Absorption Field Site: _ <br /> oving Area Soil Type ftt.." o <br /> trading Slope L <br /> Mobile Home 3. Use (d •• exactly,AMP Pero. Rate k <br /> Privy horn ,garage motel,etc Dry Well <br /> Well )(` to i..--. i ffe% Seepage Trench <br /> Subdivision Privy W <br /> Seepage Bed /e..Xa 9; . t <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- •� <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING P • <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 3 5' <br /> 5. Lot Size: Fig. A. 6. Location: :� <br /> ft. x ft. — sq.ft. lb '1 1 <br /> b <br /> ---. - C <br /> N E O' <br /> o <br /> um <br /> 0 <br /> a . <br /> 0 <br /> 7 7 <br /> ') T <br /> m <br /> Z <br /> ij <br /> 0 Z. <br /> m <br /> 5) <br /> CO <br /> CD <br /> Cir <br /> -t'''' <br /> ii cnr -0 cn .. z <br /> C c d _ m <br /> C) <br /> N a Q..< ,: a <br /> Z o5 a, . <br /> o _ <br /> /! U1 0 <br /> 'N° • <br /> Signature of Ow r or Agent Date <br /> x <br /> Remarks m s <br /> m t> <br /> G; • •444 11 <br /> kD <br /> VA <br /> Inspection Date 7.L y .' 9...„..0 ,/? e __ <br /> o 0 0• <br /> o cNii <br /> Zoning Administrator "`) o 0 0 0 0 <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 />