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Burnett County Office of Zoning Administrator --i <br /> o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> d <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> ,L rnte, ( �h.Q f... . ...5.... ' ls.k.w. �� :.................... - ,0 <br /> ......... .... . C <br /> OWNER ( lease print) CONT CTOR or SURVEYOR or AGENT a <br /> I� ...... . �a i ......... ... ...... l.. . .. . ....... ... <br /> ADORES ADDR SS <br /> o...{ :., .....m...�`r�... .off......... ....... l Ebb....LA ...�1 .......... <br /> SS ADDRESS <br /> 1..-.�J. .-. . :.-. � ................................ <br /> X50-..313 ........................................... <br /> PHONE PHONE \ 1 <br /> ........................................................................................... . . . ..................................................................................... V <br /> PLUMBER WELL DRILLER <br /> O l <br /> ADDRESS ADDRESS n o <br /> ........................................................................................... ............................................................................................ o' .G. <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> oms """""th <br /> Baro <br /> 1. Work: 2. New Building Details No. ' T o <br /> New Building No. Bedrooms <br /> Type of Construction: """"" i <br /> Addition F2./ jT),1���,,... Septic Tank Size Gals. .......... i ,� <br /> Sanitary .......... Size ft. x ... ft. " <br /> Fillingl Grading ght.. ...... Stories ............... 4a. Absorption Field Site: <br /> SoilType .................................... r <br /> Moving .......... Area ................................. o <br /> .......... <br /> Mobile HomeSlope .......................................•.. ,+ <br /> .......... <br /> Privy .......... 3. Use (describe exact) , 1 -fami Perc. Rate ................................... <br /> Well ,,........ home ora Dry Well ' <br /> ... .. 9 9 , motel, etc. <br /> .......... <br /> Subdivision � ( -�' (; � Seepage Trench .......... E <br /> Camping Unit .......... Privy .......... <br /> .................................................... <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road t7 <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 0� r <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. —_ �7, /off <br /> ----------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: I y i <br /> ................ ft. x .............. ft. . ............................... s4.ft. ............................................................................... <br /> al <br /> a <br /> 3. <br /> i-� <br /> 0 <br /> r 7 0 <br /> s <br /> w z <br /> l O <br /> d <br /> _ <br /> m <br /> M (/Ira mm2 <br /> c d d c m <br /> m on< <br /> V G b <br /> rr <br /> Z Oo � D a' J <br /> O = G p C <br /> N <br /> LsNh C <br /> Signature of Owner or Agent Date <br /> X 3 <br /> Remarks ...... .................. ... ......... ......... ... ................ <br /> n(: .fd. .v�..t...Le...r m... ... ...1. .C�.. .................... . <br /> ................................................... ..... ............................................... ..................... ....... ........... ............ � <br /> �\ � .• N N � � � N n <br /> Inspection Date ....................................... .., 1. ��......:.......1.!. .. ............. ? u, g. o . 'oo n <br /> Zoning Ad''inistratrr g 8 0 0 o co <br /> NOTE: A preliminary site Inspection must be made and s e approval granted on all st.•rJrUCIures inVOIVing 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 bulld- <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 />