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? <br /> Wrnett County Office of Zoning Administrator C - o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> 0 <br /> -O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H 0 :Q <br /> aown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> )rdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a v <br /> a <br /> ,...........t.. ... .................. Y`.4�c w(..�.............. c 4 0 <br /> ..... <br /> )WNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> . ....©..C .....1 4?. ... .<:...... .....e7T'21...-..... .......�.-5...... ................................ r� <br /> ADDRESS � ADDRESS <br /> w ..Q. ......................�.................. <br /> ADDRESS ADDRESS <br /> 1 <br /> s <br /> J...--..6..1.. ---....`?`. ...-.. . �......�............. ...:7.j ........�..�..�'..}....... o............................. <br /> 'HONE PHONE <br /> . -...' ..y .. ......�'. -. r............................................................................................ <br /> 'LUMBER WELL DRILLER :CAI <br /> _ <br /> ADDRESS ADDRESS CD <br /> 0 O <br /> ................................................................. PHONE .................................. o' <br /> 'HONE z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> I. Work: 2. New Building Details No. Bathrooms o <br /> ......... <br /> No. Bedrooms �— ti <br /> New Building ..,,....,, Type of Construction: •••••••••• CD <br /> Addition •••, ,•, S,,F'`!, a,_;�. 1!% /,'`r ...... . Septic Tank Size Gals. .......... ; <br /> Sanitary .......... Size ....1.5.... ft. x ft. .......... _ <br /> Filling .......... Height,. ..iff.'.. Stories ... ......... 4a. Absorption Field Site: <br /> Moving Area ... U...`�3. ..1=-T_. Soil Type .................................... r <br /> GradingSlope .......................................... t <br /> o <br /> .......... <br /> Rate ................................... <br /> Mobile Home .,,....... 3. Use (describe exactly, 1 -family Perc. �:. � • <br /> Privy home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench .......... <br /> i' .... .. �.: .�... : <br /> Subdivision Privy .......... <br /> ......... <br /> SeepageBed ..........---------------------------------------------------------------------- U) <br /> _ocation of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road O <br /> etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- .� a :� <br /> ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING \ k y <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. > p <br /> ---------------------------------------------------------- -------- 3 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> E,/G <br /> .'. .;5.. ft. x ..Lr�?. ft. — ..!...�`.., S� sq.ft. ............................................ CD <br /> _ ; <br /> fN <br /> Lo <br /> J <br /> �. <br /> ryr Z [� <br /> CD <br /> �o Cn DEN z <br /> CD c <br /> m, NQQ<` <br /> _ d — <br /> o cn < C . <br /> CD <br /> •--�. O 7 <br /> Ul <br /> 0 <br /> m <br /> .... ...... ... ... . ....................... �. .6..:-.. s W <br /> p <br /> 5i re of Owner o ge Date C <br /> �X <br /> R arks ......................... ......................................................... m m <br /> Co <br /> CD <br /> ................................. : o: <br /> Inspection Date ....................................... .... . ............ .... ....... 0 0 066 0 m <br /> Zoning Admi istratorKj o 0 0 0 0 o N <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> -ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> iith 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 />