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Burnett County Office of Zoning Administrator g, o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 <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 m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a EV <br /> O <br /> �S / / ..................... . � <br /> .... . .f... ........................................................ <br /> OWNERse Print) CONTRA <br /> m <br /> r <br /> LL OR or SURVEYOR or AGENT n <br /> ................ ......... ............. ... ........................,.,.:..:........... ............................................................................................ a <br /> ADDRESS ADDRESS <br /> S .. <br /> ...........REEii.....1....6..::.. 1� .........(..L...................................... ............................................................................................ <br /> :O <br /> ADDRESS ADDRESS <br /> ............................................................................................ <br /> PHONEPHONE <br /> PLUMBER. ............................................................................... <br /> . . . ..L...DR..I <br /> . ...LL...ER....................................................................... �. <br /> WEL <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS r. <br /> w o /11 <br /> a <br /> . ...................................................................... ............................................................................................ —' <br /> PHONE PHONE Z 0 » <br /> DESCRIPTION <br /> r <br /> 4. Sanitary Facilities: ° o ° :'6 <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building ....✓. Type of Construction: No. Bedrooms <br /> [' ...... <br /> Addition 'A .�G Septic Tank Size Gals. N .......... '• <br /> .......... ..........e.. . ....: .. .. r, : < <br /> �/ J ...I...... . <br /> Sanitary ,,,,,-,,,, Size .....G9.7.. ft. x .....:�.Co... ft. � <br /> Fillingf Grading ,,.,,,,,,, Height............. Stories ............... <br /> 4a. Absorption Field Site: ? <br /> Moving .......... Area Soil Type .................................... F r <br /> ........................................... <br /> o <br /> Mobile Home .......... Slope .......................................... T ; <br /> Privy ....... 3. Use (describe exactly, 1 -family Pero. Rate ................................... i <br /> ... <br /> Well .......... home,garagei motel, etc.) Dry Well Al t� E <br /> Subdivision ,,,,,,-,,, q ;r- ,: -. Seepage Trench <br /> ......... y <br /> .../.......�1...'..IE.I.f. <br /> Camping Unit .......... Privy .......... r i <br /> .................................................... C <br /> Seepage Bed .......... <br /> _____________________________________________ U <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched In Fig. A. Include road MI ' <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 /> W .� <br /> section, show the intersecting highways and the setbacks require along them and at the intersection. CLEAR LV LABEL EXISTING O <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITI NS 6N -C 3 <br /> ______________________ _____--------__ �� [ <br /> 5. Lot Size: F g. A. 6. L tion h 6` <br /> 0 0: <br /> ........................... o <br /> ................ ft. x .............. ft. -� .3f.K�- .... s .ft. .. ...�!'.`.-J1... 5�!4! .... UN a;p <br /> N <br /> » <br /> O � � <br /> J y � <br /> N W <br /> � Y <br /> 0 <br /> yy O <br /> T S <br /> //MVV D <br /> See )1-9bweeJ 71a-�I`Ui a I <br /> G <br /> o <br /> es <br /> a <br /> I <br /> i <br /> M cor v 0mZ <br /> n c < c m <br /> xa <br /> to c <br /> 6 vi m <br /> a <br /> �o <br /> Signature of Owner or Agentpat • • kv o : C <br /> L Z a X <br /> Remarks .- r. ... ..9 .: ... ........................................................................................... <br /> ' . <br /> ....................................................................................... ... <br /> ke <br /> ................................................................................................................ ................... ..... .............................. U . . . . . <br /> Inspection Date ....................................... .. .. . . .. ....... ........... ............ ............. E df U N o o m <br /> -�nm...... .... m <br /> Zoning Ad istrator 8 0 0 0 8 m <br /> NOTE: A preliminary site inspection must be male and site approval granted on all Structures involving sanitary faciliti S <br /> before construction can begin. In the case of sewe�age disposal systems, a copy of the percolation test must he attached to <br /> this application before a permit will be issued. Do tot purchase or install a septic tank, do any plumbing or start any builc <br /> - <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 Adm 'mistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />