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Burnett County Office of Zoning Administrator �' c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and0' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,$ c . <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the St to of Wisconsin. a <br /> .................................... <br /> ............................................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or, AGENT01 <br /> AD161) <br /> 1n <br /> Slreh...a..lt�tS...................syg7 .� 9J <br /> ADDRESS ADDRESS •CK <br /> 5`i— X370/ <br /> .......... ........................................ ..................................................................................... ...... <br /> ...!.p�Y. PHONE <br /> ........................................ ........... <br /> .......................................................................... ...... <br /> PL BER /' WELL DRILLER <br /> ........(,uP.///S i-...,.....:W15.................................. ..................................................................................... ...... o <br /> ADORES! ADDRESS G <br /> r6_e�d <br /> . .. ........... .......... ............................................... ..................................................................................... ...... <br /> PHONE PHONE Z « r ' <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms ... ...... c <br /> Now BuildingType Construction: No. Bedrooms <br /> Addition •,,, rdr'+^^� Septic Tank Size Gals. .... <br /> Sanitary ..X..... Size .............. ft. x .............. ft. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type ... . ......................... '• <br /> ........................................... <br /> Mobile Home Slope """' Tr4/r9 :` <br /> .......... .......Q... .................... <br /> Privy ,,........ 3. l}se-{�tescribe exact) •family Parc. Rate ... .... . . ............. <br /> Well , <br /> om garage, motel, a Dry Well .••••••.•. — <br /> Subdivision <br /> Seepage Trench .......... z ' <br /> .......... <br /> . . ............................................ <br /> Camping Unit Privy ... ...... ^X <br /> Seepage Bed .. .— <br /> ________________________________________ _______________________ __ __ <br /> Location of proposed structures and existing structures well sewage systems, roads, etc. should be sketched in Fi . A. <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is local d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. — o <br /> --------------------------------------------------------------- - d <br /> 5. Lot Size: Fig. A. 6. Location: r^ � <br /> 5/ E <br /> ................ ft. x .............. ft. — ............................... sq.ft. <br /> q0 f} <br /> 0 <br /> N O <br /> O {(7 <br /> Y <br /> 1 <br /> j ' rw <br /> Z <br /> D <br /> v <br /> N� <br /> m <br /> M in V w- Dm 1p -U <br /> m �n•c — nm o. ny <br /> > > ; <br /> ON O m <br /> D - � <br /> „ n : y <br /> p-7 no 0 <br /> F _ 111 0 <br /> c <br /> m <br /> x r, i m <br /> ................................................... ...................... ............................... ...... a O <br /> Signature of Owner or Agent Date oo <br /> Remarks m y <br /> v <br /> o . o <br /> 0 <br /> ............................................................................................................ ................ .......................................... .... <br /> T <br /> • N <br /> Inspection Date ....................................... N 0, o o m <br /> Zonin Adminis ator �»1 8 0 8 8 m <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> -an begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app)cation before a permit will <br /> issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> ,d if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or 5pecifications shall not be <br /> 'hour approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />