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Burnett County Office of Zoning Administrator 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 H o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. n <br /> .(�. ... ..y�..(. ..�Zo�..5. .C�.......... ......... .....,r..� ..�....�J ........ .... h <br /> CD <br /> 0 <br /> 'CD <br /> OWN �(�ease pnntl CONTRACTOR or S RV€BYO or AGENT � cc <br /> a <br /> ... ............................................................ , 9� . <br /> ............. ... ............................................................................. <br /> AD PR�Ss ADDRESS <br /> ...... rY.. 2. h <br /> ADDRESS <br /> ADDRESS <br /> .............G.5�..-.. .� s'. -........................................... ";5V <br /> PHONE .......................................................................... <br /> PHONE <br /> wit <br /> PLUMBER WELL DRILLER <br /> ADDRESS 'A-5 D RESS <br /> ... S-S"............................................................................ o <br /> AD <br /> m 0 <br /> 0 < <br /> PHON.E....................................... ....................................... o o <br /> PHONE z ti <br /> DESCRIPTION r- <br /> 4. SanitaryFacilities: o <br /> 1. Work: 2. New Building Details No. Bathrooms T <br /> New Building Type of Construction: No. Bedrooms .......... <br /> Addition •........ .... Septic Tank Size Gals. ... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... r- <br /> g o <br /> Mobile Home .......••. 3. Use (describe exactly, 1 -family Perc. Rate ................................... ;� <br /> Privy home,garage, motel, etc.) Dry Well .......... (41 <br /> Well Seepage Trench <br /> .................................................... <br /> Subdivision Privy t <br /> ................................................... .......... <br /> Seepage Bed .......... <br /> ________ g systems, roads v � <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTI <br /> proposed structures and existing structures, well, sewage s etc.,should be sketched in Fig. A. Include road <br /> Location of C� 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- 1 I _a <br /> NG p C <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -------- <br /> • o <br /> ------------------ l� Z <br /> ----------------------------------------------------- 0 <br /> Lo Size: 22 Fig. A. 6. Location: <br /> Uv..... ft. x ..%v.d ft. - ............................... sq.ft. ............................................................................... O o <br /> : o <br /> c � Cn <br /> � o <br /> 100 <br /> ti- <br /> o �fi �rbM <br /> 7. <br /> z <br /> Iv 7S t S�vC' r <br /> m N9? M< <br /> v rj<, ]' 0 <br /> 1--ov$� z 05' ID � � � <br /> t � o 0 <br /> ... ... ... .............................. p <br /> .,�........3..1...-...�--- <br /> Sig ature of O ner�Age Date - :N° C <br /> Remarks ... <br /> ...................................... <br /> ..........SPc G(F�l f'�7 u C 4 X 70 <br /> l <br /> ...... .......... .........:.. <br /> T <br /> ...... ..... ���...r .......�1?�u!'sti......�? t........ �'....... ...... <br /> O ......1 ryes..........�? .... .r ,.......,����.... /f .l`s�s roC .� <br /> .................................. . .................... .................. Oc6c"o <br /> UlInspection Date ....................................... Ems,./ .:�' C� -�- � 0 0 o cn m <br /> g00M <br /> Zonin Administrator 0 0 0 o Cn <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 /> tg until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> rith 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 />