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Burnett County Office of Zoning Administrator c. -00 0 <br /> APPLICATION FOR- SANITARY — LAND USE — BUILDING PERMIT ' -. o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co <br /> Drdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. ] o_ ,� <br /> 0 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o m <br /> a t Q <br /> a <br /> ADDRESSADDRESS h \-.9 <br /> co <br /> ADDRESS ADDRESS t 9,.) N <br /> PHONE PHONE <br /> k)e(s krPfr ., N. V1 <br /> PLUMBER WELL DRILLER <'C <br /> Webs,�r (,u1sc 7-403 o <br /> ADDRES � +�� O� ADDRESS u o <br /> rf ( Cl o <br /> o :+ <br /> PHONE PHONE Z ' 1- <br /> DESCRIPTION 4. Sanitary Facilities: •o o 0 <br /> 1. Work: 2. New Budding Details No. Bathrooms .0 o <br /> New Building ...N' Type of Construction: No. Bedrooms 3 v., m <br /> Addition 2-0 7 Septic Tank Size Gals. fb0V o <br /> Sanitary ..k... Size 2? ft. x .7>2- ft. •-) <br /> Filling Height Stories 4a. Absorption Field Site: -� <br /> Moving Area Soil Type or <br /> Grading Slope \ �» <br /> Mobile Home 3. Use (describe exact) Perc. Rate -�-01- - \ <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well ,,, Seepage Trench <br /> Subdivision Privy ,'` <br /> Seepage Bed ..X -- <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road I " SA <br /> - � <br /> C <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- r-.. <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. , 3 <br /> 5. Lot Size: Fig. A. 6. Location: F <br /> ft. x ft. - sq.ft. <br /> 1Ss rn <br /> t CD <br /> 0 <br /> o <br /> n <br /> _o 9J <br /> N <br /> rF <br /> 4 00 <br /> G <br /> D- <br /> z '� <br /> 0 <br /> • <br /> r v\ <br /> n <br /> CD <br /> r co <br /> Do cn r 7 * oo z <br /> co C a) c CD <br /> -a cn < c a' ,• 0 <br /> -0 <br /> h b yN * m <br /> z <br /> o (5' . `D 70 <br /> /VA ' 1-141A-1 (4 i—E119 o• i� = <br /> • yr <br /> °v o m <br /> m <br /> Signature of Owner or Agent Date 0 $ C <br /> X 4• XI— <br /> Remarks <br /> „ P m <br /> •o <br /> to _ o <br /> ...j u <br /> DDcoo N„ <br /> Inspection Date c7a7ertGa Q'`"' 'J to uirl <br /> b o b o b m <br /> Zoning Administrator /CJ o 0 0 o o V) <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 />