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Burnett County Office of Zoning Administrator C -a o z <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 0 0Q <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c4 <br /> Ordinance, Sanitation Code, and 'witth-all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 m <br /> ' e, ...9s.M. .Ckl�yl...fri�!1 eta................... ...... �X'......................... ... .... . .... ..... y o <br /> v <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> AD RESS <br /> ADDRESS <br /> e..4 /./ �/.../y.N..,S; '/. .................... ....... <br /> O ADDRESS <br /> .l wlADDRESS <br /> ................................................. <br /> PHONE PHONE <br /> ......... .... -t <...F..:.-4aa77�0 A...................................... <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS D Ch o <br /> _. < <br /> PHON.E........................................ ....................................... o <br /> PHONE T <br /> DESCRIPTION o 0 <br /> 4. SanitaryFacilities: o ° <br /> No. Bathrooms � <br /> 1. Work: 2. New Building Details 0 r�` <br /> New Building ,•;V Type of Construction: No. Bedrooms ....�... oc <br /> Addition Septic Tank Size Gals.„ „ .... .....Sanitary Size ..., ft. x .df.7...... ft. <br /> Filling <br /> �3 4a. Absorption Field Site: <br /> 9 Height............. S,�°ries ...�......... p <br /> Moving Area ......... l�..D Soil Type .................................... �: o <br /> Grading Slope .......................................... r <br /> Mobile Home „•••,• 3. Use (describe exactly, 1 family Perc. Rate ................................... .. <br /> Privy •, home,garage, motel, etc.) Dry Well <br /> .......... . <br /> Well .......... �Q . .. ........................ Seepage Trench W <br /> Subdivision Privy <br /> .......... <br /> Seepage Bed <br /> ---------------------------------------------------------------------- <br /> N <br /> l�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. 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 < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> y <br /> ---------------------------------------------------------------------- 03 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> O <br /> ft. x .............. ft. — sq.ft. ............................................................................... pID <br /> vti <br /> 3 <br /> N 10 <br /> O : O j <br /> N <br /> -, <br /> z <br /> Pr <br /> 0 <br /> tn cncoz <br /> C: a) ID <br /> m Naas — + n. <br /> o cn < C : �' � <br /> oNti < � � m <br /> o <br /> 6q <br /> o <br /> signature of Owner or Agent / Date ° <br /> X 70 <br /> 3emarks .Privy..MUS.t.•be..Iacated..at..l.east.:.....25'....frsum..dweU",...��.:...f.�o�..�P.�..l n�.�..... „ m <br /> 0 <br /> CD <br /> O. 4y/� ............2�'...f r.Qm..2.0%..s.J Qpe.,............ �' <br /> . ........ .. <br /> .% <br /> ............... ...7.5.'...frotn lake...4r...stream. <br /> ..................................................................... +N fl T <br /> , v <br /> nspection Date ....................................... ta: o o cn IT! <br /> U Zoning Administrator Al Cc, <br /> o fn <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> More construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> is application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith 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 />