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Burnett County Office of Zoning Administratord 0 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 0" °, <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c 1� <br /> Ordinance, Sanitation Code, and th all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> le 0 <br /> ................. .... <br /> OI (plea ge pri�) � CONTRACTOR or SURVEYOR or AGENT <br /> ............................................................. ............................................................................................ <br /> A D D R Ea) ADDRESS <br /> tis �n . .. '.1.....s3 <br /> .............................. . ......... ............S- ..................................... ........ ....... ...................... � <br /> ADDRESS y _� ADDRESS <br /> .3 l ( . �o <br /> ...................................... ............................................................................................ <br /> PHONE PHONE :o $ <br /> ........................................................................................... ............................................................................................ :U <br /> PLUMBER WELL DRILLER <br /> 0 <br /> ........................................................................................... ............................................................................................ _. <br /> ADDRESS ADDRESS m L7 <br /> n o <br /> ........................................................................................... ............................................................................................ o .: <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> th <br /> Barooms <br /> 1. Work: 2. New Building Details No. ••�••����� o ' <br /> New Building Type of Ggnstruc@io 1 No. Bedrooms .......... <br /> 73 <br /> Addition ✓ rC,2�=„h,•,GL.�.6.0..... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ....IU..... ft. x ...... ft. .......... <br /> Filling/Grading ......,,,, Height............. Stories .....A........ 4a. Absorption Field Site: <br /> Moving .......... AreaSoil Type .................................... r <br /> ........................................... <br /> Mobile HomeSlope .......................................... 0 <br /> Privy ,,,,,,,,,, 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well <br /> Seepage Trench .......... : s! <br /> Subdivision .......... p ., <br /> ............. I.. . ........... y ./ <br /> Camping Unit / �i C✓• .......... Priv .......... '�I', <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched in Fig. A. Include road I �� <br /> � <br /> setback, side and back yard dimension and location and setback from all bodies of waterD- 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 /> STRUCTUHFS AND PROPOSED STRUCTURES AND ADDITIONS. r <br /> —_.-------------- <br /> 5. Lot ize: < d`u” t-, Ig. 6. Location------------------------ <br /> — E <br /> V I ; <br /> V <br /> .....I. ....... ft. x ..a......... ft. — ......d..........._L{1.... ......................................................................... <br /> sr4P /ham 30 <br /> 0 <br /> -5je� r �� <br /> s <br /> N <br /> o Z <br /> S6 <br /> d <br /> �' �tfioti <br /> 4-te <br /> l M tor- M .N m Z <br /> n Q < c m <br /> N N a ¢ <br /> am <br /> C o c <br /> z o o 0 y a m <br /> m 3 <br /> 0 <br /> Signature of Ow er or Agent Date X <br /> Remarks <br /> M <br /> � � � � � <br /> v ' <br /> \ n <br /> Oy: <br /> m <br /> InspectionDate ....................................... .. .. . . .... . ............ ............... m <br /> Zom Administrator 8 8 8 8 8 8 y <br /> NOTE: A preliminary site Inspection must be made A d site approval granted on all structures involving sanitary facil tos <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 stat 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 />