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Burnett County Office of Zoning Administrator iu - o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < _ :",1 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c ;� <br /> Ordinance,, sanitation Code,and with all other�applicable County Ordinances an a la and re ala ns of the State of Wisconsin. a i� <br /> V o... .1�...1.L...... � � .�P S 3 �V <br /> ......................................... <br /> OWNER Ipl se print) CONTRACTOR or SU RVEVOR ar AGENT n <br /> ..�-..-...� o. . . a <br /> ADDRESS <br /> .. . ......( ..5..,.1....PC..�..y...".Y..�.....`:r'...cl.L.�.V........ . . . . . ................................................................................. <br /> ADDRES ^ -'� / ADDRESS <br /> ................/,. .�F. ..��.5......................... <br /> .......... <br /> ........ <br /> .... <br /> . .......................................................................................... k� <br /> PHONE <br /> 7 <br /> (S J / � <br /> . . . .`...........................................................................— ............................................................................................ :� :� <br /> PLUMBER WELL DRILLER y'� <br /> ............................................................................ ............................................................................................ <br /> ADDRESS ADDRESS 0 0 <br /> o <br /> +� <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: v ° 1 <br /> 1. Work: 2. New Building Details No. Bathrooms .... 7?� o i <br /> yy.... <br /> jmf <br /> New Building ,,,,,,,,, Type of Construction. No. Bedrooms ...l...... c\2.;p <br /> Addition r'4 w.o -. Septic Tank Size Gals. ......... �}'i"Z' <br /> .......... ... .... �: < <br /> Sanitary Size .��. ft. x .. ?' � . <br /> . . ... . . ....... ..... . . ..... <br /> ... ...... .. .... ft. <br /> Rillingt Grading ......4... Height............. Stories ............... 4a. Absorption Field Site: i� <br /> Moving .......... Area .......... ............. Soil Type .................................... Or <br /> ............. <br /> 9i :G <br /> Mobile Home .......... ...... Slope .......................................... o <br /> Pere. Rate ................................... <br /> Privy ,,. ..... 3. Use (describe exactly,6: t <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> i <br /> Subdivision .......... Seepage Trench .......... :� <br /> .................................................... <br /> Camping Unit ,,,,,,,,,, Privy T '. <br /> --------------------------------------------- Seepage Bed--------- ' N j <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. I1 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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 91fa' <br /> ------------------------------------------ :O <br /> 5. Lo Si{{e: q O, �,� hr3 Fig. A. 6. Location: d C <br /> ft. x ..J�.1...1 ft. — .. <br /> ......... sq.ft. ............................................................................... <br /> m <br /> O J <br /> J <br /> lif, <br /> T, <br /> "5yy •rt p � `:o <br /> Z <br /> 0 <br /> m L2; <br /> Nd m <br /> v c c m <br /> m <br /> P o <br /> of - <br /> o <br /> m <br /> �1« ... !.w. ..................................... o <br /> Signature o Owner or Agent... Date ' C <br /> Remarks .[. .-. .. ..�:......................................................................................................................... x p <br /> l..`..L^'1jEC7j ..�rf...(�C_r' s i <br /> ''..........................:................ ..................................... .......... ..... ........ .......................................... <br /> Inspection Date ..... <br /> o o n <br /> .. .....-1.: .. ....... m <br /> Zonin Administrator <br /> $ $ $ $ o o 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 />