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Burnett County Office of Zoning Administrator d 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 o <br /> shown herein. The unde;..igned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinancd, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> 5 <br /> o <br /> .. ..................... <br /> u .................... ....o" . .......................................................................................... :^ <br /> d <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> 6` rJ.y........�.........✓..�...................................� .... . .......................................................................................... <br /> ADDRESS ADDRESS w <br /> .................. <br /> ..1 ti'a /'7r� 55 �r3S <br /> . .............................................................. . . . . . . . ............................................................................. w <br /> ADDRESS <br /> 61 .94 ADDRESS <br /> ......... , ,x,-. ..................... <br /> PHONE ...... .PHONE................................................................................ <br /> i, <br /> ...................................................................................:....... <br /> PLUMBER . .......................................................................................... o <br /> WELL DRILLER <br /> iT <br /> .................................... ...... <br /> ........................ ......................... . .......................................................................................... <br /> ADDRESS ADDRESS <br /> m G) <br /> o <br /> .............. . . <br /> c <br /> PHONE .............................................. ............... . <br /> o <br /> PHONE . ................ ..... n <br /> DESCRIPTION 4. SanitaryFacilities: 3 ° o <br /> or , ' <br /> 1. Work: 2. New Building Details No. Bathrooms .......... ? i <br /> New Building .......... Type of Construction: No. Bedrooms ...... .. <br /> Addition ....Y /'✓Q.H. ••••...„•.....•........•• Septic Tank Size Gals. 1.2Sanitary .......... Size ....La..... ft. x .....��...`/... ft. .......... y? <br /> Fillip /Gradin ' 4a. Absorption Field Site: n: <br /> Filling/Grading .......... Height...7....... Stories .............I. p <br /> Moving .......... Area ........ .. .. .....F.t 2.......... Soil Type .................................... p m rt <br /> Mobile Home .......... Slope .......................................... :.1i• <br /> Privy .......... 3. Use (describe exactly, 1 -family Pero. Rate ................................... •u Vn :A.1 <br /> Well .,......,, homeDry Well,garage, motel, etc.) .••....... •r, y. E <br /> Subdivision L,1Uw'J �ooM Seepage Trench .......... o <br /> .......... . ..... ................................... .. <br /> Camping Unit Privy N <br /> .......... .................................................... ......... <br /> ------- Seepage Bed .......... o °C <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road T ` e <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter O on <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> _. <br /> -------------------------------------- <br /> -------------------------------- <br /> 5. Lot Size: - X I i 3 h 4 I Fig. A. 6. Location: <br /> 3�y g' :rb o <br /> .....�.V. ..... ft. x .............. ft. — ..�.......................... sq.ft. ............................................................................... :n <br /> C e <br /> t p16' <br /> . . -.. N 'p i Iv o. <br /> c b c <br /> iG91 wt _ <br /> �>a o 4 �? <br /> ry <br /> s o <br /> _ d <br /> � amz <br /> fcr - <br /> a) <br /> oo' � aom <br /> Z <br /> ,/�, //,y f' _ i 0 D e"�-,ems' %�•C. rz r 7` R 70 <br /> m <br /> �. '..� ...... <br /> Signature of Owner or Agent Date Su<rK r✓ o C <br /> Remarks .......... ✓ tc .e.......e5?Cef.! I/e,rc'...... :'.ilk �a,:-c,c-�c� %.,i :`xCt �P �Ca” r x . m <br /> . ........... ............. ..........:�....I ,/.................................. <br /> M.y....../ Bathe,-'s.... :�.........?.a:.r�....:<......5.............. c:'....... ?.y....... ..................... <br /> ................................ .. ... :c <br /> Inspection Date ....................................... m <br /> u v ou ou m <br /> Zoning ministrator g g $ g g g to <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. Aperm it 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 lie marle without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT ,BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> a111P S3yo <br />