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Burnett County- Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < 7 :p <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 <br /> /ta <br /> .... ...�?.n.a.. ........................ . . . ........ .......................... ......... . . . . ........................................................................ <br /> II A <br /> OWNER (please print) .y- v CONTRACTOR or SURVEYOR or AGENT a �' <br /> ....?....9.x..4................................................................... <br /> App ESS ADDRESS <br /> .� <br /> ADD ESS ADDRESS <br /> ................................ ........................................................ ............................................................................................ :\ <br /> PH I� PHONE <br /> ..... .............................................................. .................................................................... w <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... .AD......DRES."'E'S".............................................................................. <br /> ADDRESS S �� m Ll <br /> n o q <br /> PHONE PHONE Z r- <br /> DESCRIPTION 4. Sanitary Facilities: 00 0 0 :A <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building .......... Type of Construction: No. Bedrooms ...�--. <br /> Addition ' 9 P./',,,,,,,,,,,,,,, Septic Tank Size Gals. a. � '•� E <br /> Sanitary ... °�, '< <br /> y ?�.. Size .............. it. x .............. ft. 4a. Absorption Field Site: <br /> Filling/Grading .......... Height............. Stories ............. . i <br /> SoilType .................................... i r <br /> Moving .......... Area ........................................... � 0 <br /> Slope <br /> Mobile Home .......................................... 3 <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... It <br /> Well .......... home,garage, motel, etc.) Dry Well .......... y <br /> Subdivision <br /> Seepage Trench """"" <br /> .......... A <br /> Camping Unit .......... .................................................... Privy <br /> Seepage Bed <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- 4 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING W m <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 5. Lot Size: Fig. A. 6. Location: <br /> w: <br /> ................ ft. x .............. ft. — ............................... sq. ft. .............................................................................., I <br /> rn <br /> N o' <br /> o � <br /> 5 :\ <br /> �1 0 <br /> 0 <br /> F <br /> M CIA, <br /> 0 <br /> Z33T <br /> o \ <br /> m <br /> m <br /> m <br /> a' xa C <br /> 'p .�' m . oT <br /> Z o o Dn L <br /> 0 0 n ro <br /> 1 \e0 <br /> Y N o <br /> ... .. .................. ..................................... :�ij o C <br /> ..... .... ...................................... ' o m <br /> Signature of Owner r Agent Date — <br /> Remarks .lf '1. ...,.:L.a^...1.:[:'.L:.`..( ....... T � � � � v <br /> .9...... ......... ..... ...... .... .... ..... .......... ........... ..... ..... .... ....... . .. . .. <br /> L / _ [ <br /> f <br /> Inspection Date L...::.-. C..C'..:-..-./.i.rP... ... ....... .... . ... ...... .......... . . . ...................... i o o m <br /> Zion g Administrator 8 8 8 8 8 8 N <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 Arlministratot. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />