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Burnett County Office of Zoning Administrator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. n <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < H -e 7`d <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n x N <br /> .. ..+.n... . .. ..... .,.......'1.. s N o <br /> ...... ...................... 'o'r''................................................................ <br /> OWNER (PI ase int) CONTRACTOR or SU RVEVOR or, AGENT v. <br /> .. .� `a�l � <br /> A �e... ..... ...................... ................................................................................ <br /> EADDRESS D ............ d <br /> .. L <br /> ............ <br /> �G <br /> y.� <br /> ADDRESS ADDRESS <br /> Qy/Q q <br /> PHONEO.I .-.1.P./.. •{•O..I..1............................................. .PHONE................................................................................ <br /> �t <br /> ........................................................................................... .W...ELL..DRI.... .......LLE.......R.................................................................... <br /> PLUMBER <br /> ........................................................................................... .A....D.DRESS...... ............................................................................... O M <br /> ADDRESS <br /> n o <br /> n <br /> . ...................................................................... .PHONE........................................................................................... —' <br /> Z N <br /> PHONE H <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .......... •.,: vo i <br /> No. Bedrooms .......... -0 <br /> New Building ,,,,•• Type of Construction: m <br /> Addition ... ..................... ............ ................ Septic Tank Size Gals. <br /> Sanitary ... ...... Size ....1.AlA-., ft. x .. .... ft. .......... <br /> 4a. Absorption Field Site: i <br /> FillinglGrading •„......• Height............. Stories ............. . .m <br /> Moving Soil Type ................................. .. <br /> .......... ........................................... :� r <br /> ^v <br /> o <br /> Mobile Home .......... Slope .......................................... <br /> .-. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .,.,,,.,,, h e, garage, mot etc.) Dry Well .......... I <br /> Subdivision ,,,,,,,,,, A �' _ Seepage Trench .......... �C r <br /> /��,"J! f.r. . ..... .... . . ....... <br /> Camping Unit .fT'�g•'*'1• Privy .......... n <br /> .......... ..ax....................... <br /> • Seepage Bed .......... <br /> ---------------------------------------------------------------- <br /> Location of proposed structures and existing structures well sewage systems, roads etc., should be sketched in Fig A. Include road '•Ai <br /> cr- <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ?rp n <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> b i <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ; <br /> ---------------------------------------------------------------------- <br /> 5. LotLocation: <br /> iz / V Fig. A. 6. <br /> .�f2./� ............................................................................... o <br /> .�... ft. x .......... ft. — ............................... s9. ft. (Z <br /> \ N <br /> N O <br /> O T O <br /> 7 <br /> b <br /> O <br /> M1 .0 ' O <br /> y S <br /> Weld c* .o <br /> ® 00 <br /> "A o <br /> e :L <br /> S7 Ny 9 � m Z <br /> n o < m c m <br /> Add?•a a a �” - <br /> 6� t q Zoo ° a <br /> o <br /> Gof. ��>.... ..... : . .................. ......���a3..1.F1. ... � p <br /> Sigture Ow er or Agent Date ° C <br /> na <br /> : <br /> ` X � <br /> Remarks J.6-(/./ ''...C�•. ...? ..1Vyr� ... L1.. �i.rn.4Gg'?!.............................................................................. 0 <br /> ........................./.................................................`.............................................................................................................. <br /> `� II <br /> .......................................................................................................... . ...... ............ ...... .....,........... ............................. <br /> - ?���i <br /> Inspection Date ....................................... � 2�4. . ..? �..... ............... E 8 8 8 8 8 8 m <br /> m <br /> Zoning Achrikilistrator <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitwo <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 bnlld- <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 />