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Burnett County Office of Zoning Administrator 1, 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 < v, Ijµ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 c- <br /> a <br /> J 'n <br /> AV. <br /> y� <br /> �,(,,'�:U.. _.i/..jy' ............................................................ ....":...`.Y...••4•• ••••L..................................... C <br /> OWNER (ple�r`M/"'tl CONTRACTOR or SURVEYOR or AGENT a `r <br /> .......................... 1�J � ...<G� ....... SY.. y3............................. dam^ <br /> ADDRESS ADDRESS ,. . <br /> .................................... ....... <br /> . .:-.ya. ..�r......................................................... <br /> .............. .................................. <br /> ADDRESS ADDRESS <br /> ................................................................................ ............................................................................................ <br /> PHONE PHONE vU� <br /> PLUMBER ............................................................................................ <br /> WELL DRILLER E , <br /> . ...... . . ..................................................................—.......... O ' <br /> ADDRESS ADDRESS <br /> n p <br /> PHONE . .......................................................................................... � H - <br /> PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathroomsno :k",.......... I <br /> New Building No. Bedrooms o <br /> Type of Construction: ' <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary Size ft. x ft. ••• ••..•. <br /> Filling/Grading ,-,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type ................. <br /> .......... ........................................... ................... <br /> Mobile Homei r i <br /> Slope <br /> h o <br /> PrivyPere. Rate ................................... 3 <br /> .......... 3. Use (describe exactly, 1 -family o <br /> Well home,garage, motel, etc.) Dry Well .......... F i <br /> Subdivision ✓,.,. Seepage Trench .......... m <br /> Camping Unit .......... .................................................... Privyrt <br /> .....................4.............4................ p a g .......... <br /> See e Bed .......... i <br /> ---------------------------------------------------------- ___ <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- r �- <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. q <br /> —' <br /> 0 <br /> ----------------------------------------------------------------------- <br /> 5. Lot Size: <br /> Fig. A. 6. Location: a ' <br /> ............................................................................... <br /> ................ ft. x .............. ft. — ............................... sq. ft. o o <br /> cn <br /> J <br /> par 7a � o 0 <br /> Zxw �� <br /> o f: <br /> o <br /> t � <br /> m <br /> M y\r -o � N to 2 <br /> 0 c-N o c R <br /> m p n _ — n F <br /> a < m ro cm 'O <br /> H � am <br /> Z a <br /> o <br /> o m 3 <br /> v> - <br /> :w � �o <br /> v\ m <br /> ........................................................................... ...................................... W1 o <br /> Signature of Owner or Agent Date C <br /> X . . . . . . <br /> Remarks ......................................................................................................................................................................... T .� m <br /> v <br /> .............................................................................................................................................................................. to <br /> r n i <br /> ....................................................................................................... IsI <br /> .. UI <br /> .. . . <br /> Inspection Date �,/...... ' c . d T <br /> . 8 <br /> P ....................................... .2?k4.. . .... .i2..F... ..2.%6.�.......................... u u o Pn o <br /> Zoning Adr(inistratorK u a 8 8 8 8 8 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 Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />