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Burnett County Office.of-Zo—ning Administrator d - 1 CD o Z <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT —gyp 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located ap o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use„ t c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. tj a E 1 <br /> OWNER 1 lease nn�Yi1 J`d' ` +�-- <br /> O <br /> .................................... N r <br /> P P t) CONTRACTOR or SURVEYOR or AGENT � rCD <br /> ADDRESS ADDRESS E P+ <br /> a?AN +5 Y <br /> ADD ESS ADDRESS LW. r <br /> N ' <br /> f .................................................................................... C> <br /> PHONE PHONE %. <br /> kill <br /> ............ _ \ <br /> PLUMBER WELL DRILLER <br /> V) <br /> ..... . . . ............................................................................... <br /> ADDRESS ADDRESS <br /> m 0 <br /> o <br /> PHONEPHON.E....................................... ....................................... O o <br /> DESCRIPTION 4. SanitaryFacilities: ° o <br /> 1. Work: No. Bathrooms r` <br /> 2. New Building Details ••••• •• <br /> New BuildingT No. Bedrooms <br /> ype of Construction: <br /> Addition ...!...... ...............�...,. ....................l....... Septic Tank Size Gals. <br /> Sanitary .......... Size .. �...-y ft. x .. 3....� ft. .......... <br /> Filling •........• Height . ..... S ories ...�.. ...... 4a. Absorption Field Site: <br /> Moving .......... Area ...S C.�...... Soil Type .................................... 1 r <br /> Grading Slope .......................................... <br /> ,. o <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Dry Well Privy .....•••.. home,garage, motel, etc.) ......•••• <br /> Well Seepage Trench <br /> ���.� ..... 1V1tL:`............ .......... <br /> Subdivision jl Privy <br /> .M ..................................... <br /> Seepage Bed .......... <br /> ------- <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road 7C: <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <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. `'U <br /> �. <br /> 5. Lot Size: Fig. A. 6. Location: <br /> . �?... ft. x .(�J4t p. ft. - ,......} sq.ft. ..............................................:............................. .. : <br /> Cn <br /> CD <br /> 40 <br /> 2,4N - p <br /> F17, LA <br /> 7E �. <br /> >. <br /> to <br /> o ` <br /> CD <br /> 0 �- <br /> k7Cis7��� T>oTP'rc►�j <br /> Ml c r- - CD CD <br /> I11 ' -- c m <br /> LD. <br /> oy. c : c � m <br /> v Z oo' ° fD <br /> o <br /> 6qLn <br /> Signature of Owner or Agent Date _ <br /> • X <br /> Remarks , '? ?u ..� /D/�/.7..... -)°?..JZua- m m <br /> ...... ............................................................................................ <br /> m � <br /> ................................................................................. <br /> � : <br /> Inspection Date ....................................... \ : o 0 0 o cr, m <br /> 9 ............ <br /> Zonin Admin' trator c o o 0 o ccn <br /> 40TE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> refore 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 plumhing or start any build- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> vith 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 />