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Burnett County Office of Zoning Administrator d o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o ks <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as ?t <br /> W <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� ;V <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> SCHM�07 ...lac /5.......lU............... .... ......... N 'apo <br /> n <br /> a <br /> OWNER (please printl CONTRACTOR or SURVEYOR or AGENT a <br /> .... :tA <br /> NC.. ST � /Nd/ ......... ... ............ . ............................................................. . . <br /> ADDRESS <br /> Amcp <br /> E <br /> ..� ..... ... ... <br /> ... .. ... ........ ................................................................................... <br /> ADDRESS p/�pK ADDRESS 's <br /> PHONE PHONE <br /> L4 '....�/r7�e1i�........................._................. <br /> . . . ..................................................................................... l� <br /> PLUMBER WELL DRILLER <br /> .......... <br /> ........................................................................................... .................................................................................. <br /> ADDRESS ADDRESS ?� m o <br /> PHONE PHONE <br /> Z0 <br /> DESCRIPTION 4. Sanitary Facilities: o ° 'ff <br /> i. Work: 2. New Building Details No. Bathrooms o ? -\ <br /> ........ <br /> New Building „V/.. Type of Construction: No. Bedrooms ..,�'..... "j � <br /> .... . ' t• ..... ..............Adtlition ..... Septic Tank Size Gals. ...... <br /> ... <br /> 'V < <br /> Sanitary ;, .:.vZ-.... ft. (.G"" ' °� 'T <br /> ✓.. Size . ft. x . 4a. Absorption Field Site: <br /> Filling/Grading Height......//...0.. Stories ../.' <br /> ./........... <br /> Moving ... ...... Area ....71:.7M.0 Soil Type .................................... m <br /> .' 1........ ............. A <br /> Mobile Home ..... Slope .......................................... 3 .. <br /> Privy ..... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .... Dry Well <br /> ...... home,garage, motel, etc.) """"" F <br /> Subdivision Seepage Trench .......... ti i <br /> .......... ..�..T�/. !�f(,�.y...K1G �r............. r, <br /> Camping Unit .......... Privy............. ................. .rr .. 3 <br /> Seepage BedtL <br /> __________________________________________________ ________�.1 - i\ .00 <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road C Q N <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highway Inter- w d <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. .^ o <br /> --------------------------------------------------- ----------- :4 <br /> 5. Lo(I/, �ze:l Fig. A. 6. Location: t'' ^ U <br /> ...JU ...... ft. x ...... ft. . ............................... s4. ft. ............................................................................. o <br /> is <br /> ,Z <br /> ' SEP N :1 o <br /> �A, n <br /> 4s <br /> o <br /> 36 `� <br /> . < <br /> m �na� <br /> a < C ' <br /> Nm <br /> . m <br /> Z O o p <br /> oon 3 <br /> En — <br /> $CiyC. �E/ . . . ./.... ....... ........ �e ......... :�m <br /> ZC�f/.K// m <br /> Ignature o wner or Agent p� ate V o C <br /> Remarks( <br /> GG � <br /> . <br /> � i l/ {Jt O <br /> .......................................................................................................... ............ <br /> � / :O <br /> eim�0 <br /> .7..^ ... . ... .... C%` . .... ....Inspection Date . . . .......i. ... . ...................... <br /> Zoning <br /> $ $ $ $ $ $ in <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 he 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 peirnit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes In plans of 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 />