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Burnett Courjty Office of Zoning Administrator W ' o 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 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> JON N..F: MosT A/Y1JR.E!!! ..... .................... <br /> 4 ... . ..... = d o <br /> .. rt..!�NA SELF........... . . . . ...................................... <br /> OWNER (please print) JCONTRACTOR or SURVEYOR or AGENT m <br /> n <br /> P'P9r-L <br /> '7.3.1................ .............5..`....................................... ............................................................................................ '^ C <br /> ADDRESS ADDRESS :h <br /> ,#. v ;ice <br /> Pf-e f.. e ! / .W.(.F.......... ..�.Q. y.................. . . .. . . " 'UJ <br /> ........................................................................... .PHONE........... .................................................................... <br /> ADDRESS ADDRESS ( <br /> CQ <br /> .. ............. . . . . ; i <br /> PI-y01yE :V <br /> 11c�. s................................................... ..................................................................................... <br /> e CEJ <br /> BR 1 WELL DRILLER <br /> ........................................................................................... .. ...... .............................................................................. O <br /> ADDRESS A..DD.. RES..S m 0 <br /> ........................................................................................... ................................................... ....................................... o' <br /> PHONE PHONE <br /> Z H r : <br /> DESCRIPTION 4. SanitaryFacilities: / ° o ° <br /> 1. Work: / 2. New Building Details No. Bathrooms ... ;� <br /> o <br /> New Building ,-. Type of Construction: No. Bedrooms .....�,... <br /> Addition ,�'p&4Af?..IFYF..�Q.I.Pf..B„W.Q.Rp T6 F? Septic Tank Size Gals. <br /> Sanitary .... ..... Size ....i�. ..... ft. x ....W... ft. <br /> 2 4a. Absorption Field Site: ;F <br /> Filling/Grading .......... Height.10. Stories ............... . '?� <br /> Moving Area ....I..... Soil Type .............. ..................... fi r H <br /> Mobile Home Slope .......................................... r o <br /> Privy „ ........ 3. Use (describe exec y, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etcT— Dry Well -- i <br /> Subdivision .......... .................................................... Seepage Trench .......... i J <br /> Camping Unit ......_... Privy .......... <br /> .................................................... Seepage Bed <br /> 0. ... . <br /> ---------------------------------------------------------------------- <br /> be <br /> Location of proposed structures and existing structures well,sewage systems, roads etc., should be sketched in Fig A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 1 a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ^Y l <br /> VN <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 1�' — <br /> o <br /> ------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: �'✓ ` m <br /> ................ ft. is .....r,.. .... ft. - ............................... sq. ft. ............................................................................... <br /> n 106.8— s� <br /> 0 <br /> 0 <br /> N <br /> WAL k pt,� vl <br /> �� $fit seM FNt <” 0 <br /> LoNG. -� <br /> Z <br /> 3q9 pR 1 vEN <br /> WELL <br /> WALK <br /> LN m Z <br /> /��`� D Ur p_ C�e m c a <br /> SEPtrC TANK . m m <br /> D n <br /> DRRiN F�81� prcK �'B. : 3 <br /> siIII <br /> 8 s'C) i <br /> 0 <br /> m <br /> p <br /> Signature of 0 nernor Agent Gam,, 4�( X133 �.�,_..,1,� i� <br /> Remarks ....!- Arvu..... 1 .../!1_may \ J ... ... ................... <br /> .. ... .................. .... <br /> .. ...... <br /> .... ............ 0 <br /> 6f -Z61 <br /> N auF.•.................................... , <br /> ............................:,... .............. ........... ... .................................... . <br /> m <br /> 0 �,/ — . <br /> .......... <br /> ........ .......................... <br /> InspectionDate ... ................................ ............. .................. .................................. <br /> Zoning Adm888 8 <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />