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Burnett County Office of Zoning Administrator sl 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H µ :� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m <br /> Ordinance, Sanitation Cade, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> ........ ot.!A.'i/...4.`....LI o <br /> O <br /> .. .......................................... ............................................................................................ m <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a `� <br /> . . ...... . ............................................................................... 4� <br /> ......................... . ............................................................. . . . . N <br /> ADDRESS ADDRESS � <br /> ..........� d kG-.-. :� :. ......................... ....................................................................I....................... <br /> ADDRESS ADDRESS <br /> ............................................................................................ <br /> PHONE / PHONE <br /> ...............l...b. . .. ...b9.. ...-3.1..7./............................... ............................................................................................ U <br /> PLUMBER WELL DRILLER \ <br /> ........................................................................................... ............................................................................................ � <br /> ADDRESS ADDRESS m � <br /> o <br /> o............................................................................— ........... ............................................................................................ .: <br /> PHONE PHONE Z M r <br /> DESCRIPTION 4. Sanitary Facilities: / P o ° <br /> 1. Work: No. Bathrooms -0 <br /> 2. New Building Details """1"" o <br /> New BuildingType of Construction: No. Bedrooms ...o`C..... i� <br /> m <br /> u Septic Tank Size Gals. .......... ` :+ <br /> Addition ...jl.... .................................................... \J <br /> Sanitary .......... Size ...L�..... ft. x .... ft. .......... x <br /> 4a. Absorption Field Site: `f !d �N,� f <br /> Filling/Grading ,,,,,,,,,, Height..$.'....... Stories ../...... po <br /> ... . <br /> g ........,�!/0...6si....f#r Soil Type ................... f� i m <br /> Moving .......... Area __77 .. ............. �/• ,fes' � ° <br /> Mobile Home Slope ........................../.�lY(`.... .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well <br /> `�. <br /> Well .......... home, garage, motel, etc.) Dry """"" <br /> Subdivision ��, �� � r� Seepage Trench .......... \ <br /> .......... i <br /> Camping Unit Privy .......... <br /> .......... ...............7........I....... ...I............ <br /> Seepage Bed .......... gJ <br /> _--------- ------------------------------------------------------------ > N <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING Cy < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... V� <br /> N. 00 <br /> n <br /> N o. <br /> o � <br /> t � � <br /> 10 z • <br /> I i i <br /> —-- Cp s ---- --- - ---- <br /> t, HowIA)& <br /> P 7-VK <br /> f <br /> 9!' r <br /> P <br /> CQ RrN '> M ad m g m to Z ey s c a <br /> o Kiln < m_ B E <br /> D y a m <br /> _ <br /> ,k <br /> S LA K - -- <br /> /� �o I °t aa M <br /> Signature of Owner or Ag ( Date / �{-���� I` <br /> Remarks ..... !v......i(.P ?249.�..... !:�A/'�,.......!W. �'.�.. . !...^...:.`:1 .... .... ................... ✓� X 0 <br /> � ` `� <br /> Velk;C7 .1. '....... res ......arr.. c '14,......................!,............................................................. ee <br /> 11 <br /> b : <br /> T m <br /> .... ............................................ d. Nt�i� ou oa <br /> Inspection Date ....................................... ..... .............. i I m <br /> Zoni Administrator 8 8 8 8�8 to <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 hudd- <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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />