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7 <br /> Burnett County Office of Zoning Administrator W 0 -L! <br /> o <br /> aitPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. J <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br /> � <br /> : <br /> shown herei n.'The unrn <br /> dersigned agrees that all work shall be done in accordance with the requirements of the So County Land Use m mu :V\ <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n :G`x <br /> ............................................................. N. <br /> OWNS (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .........j�?r .4.s..s.�.... .. . . .............................................................................. <br /> D 1 } <br /> ADRESS� ADDRESS ^ �4 <br /> ADDRESS <br /> NN • • • ADDRESS �D <br /> ' <br /> .. . . .................................................................................... . . . .................................. <br /> PHONE ................................................. <br /> PLUMBER WELL DRILLER \ <br /> ADDRESS ADDRESS :Cly m 0 <br /> _. c <br /> PHONE (c 3 5' --- 24L�"J PHONE Z ,n r <br /> DESCRIPTION 4. SanitaryFacilities: 0 0 0 <br /> '— <br /> 1. Work: 2. New BuildingNo. Bathrooms """"" c" -a • <br /> Details z <br /> New Building ,,,,,,,,,, Type of Construction: No. Bedrooms """"•' \ <br /> .... <br /> Septic Tank Size Gals. ...... 'J ip <br /> Addition .......... ....... ............................................ Sep <br /> Sanitary ..!�.. Sire .............. ft. x ft. """"" , <br /> ..... ........ <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Area ...........................................Moving Soil Type ....................... .......... r <br /> o <br /> Mobile HomeSlope .......................................... .+ <br /> .......... �+� <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... at ` <br /> Well .......... home,garage, motel, etc.) Dry Well .......... d i <br /> SubdivisionSeepage Trench .......... <br /> .......... .................................................... <br /> Camping Unit Privy .......... �. <br /> Seepage Bed ...... — w <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road r Q <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. o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> p <br /> P <br /> N O <br /> O J <br /> J <br /> O <br /> 0 <br /> �V J <br /> S <br /> D <br /> 1 \r <br /> ^ .� <br /> Z <br /> O <br /> d <br /> J <br /> b <br /> m <br /> NN, <br /> G N 9 G 6 m <br /> Nach <br /> < m <br /> O b - y m <br /> M <br /> Z o0 nn <br /> fH _ <br /> O ' <br /> O ; <br /> J / m <br /> w. .........: ...:�.Z?../.�......... <br /> ei�na <br /> g re of ner or A ent Date — <br /> � x oRemarks mf CO+ '..u!�+- �. m m <br /> ..........���./.l`..< ��.... :.c^.:Z,". .Z-:................................................................................................................................. <br /> II <br /> ....................................................................................................... ............ .............................................................. ` : : T <br /> Inspection Date ..7...I�:..`.1r.:5......... rte•o. .. ........... .. ...................... ; Ic; N — m o "F m <br /> vvv o Horn m <br /> Zoning Ad inistrator S 8 8 S o 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving 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 build <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 be made without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />