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Burnett County Office of Zoning Administrator &n M 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as 7 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c O <br /> Ordinance, Sanitation Code, and with all other applicable Count Ordinances and the laws and regulations of the State of Wisconsin. 3 a :1 <br /> PP Y <br /> 01 <br /> ........................... .............................. . . .................................................... <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT n ss <br /> �•� �/�SD��I/, X10, °- , <br /> ADDRESS <br /> ADDRESS <br /> 1{�tF i7�✓ ��y C� <br /> ................. ................ ............................................................................ <br /> ADDRESS �2 ,a�1,?z.— � L)G ADDRESS <br /> ................ <br /> 1P1.2.... Ci/..-. Lr3...n.....i✓u ....... <br /> ........................................................................................... <br /> PHONEPHONE <br /> ............................................................................... . <br /> . . ...D..RI. .LLER. . ....................................................................... <br /> PLUMBER WELL.. <br /> ........................................................................................... .A..............RESS............................................................................. 0 <br /> ADDRESS DD <br /> M <br /> o <br /> . . .................................................................... . . .................................................................................. —' <br /> PHONE PHONE...... .. Z ? '` <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> • o i <br /> New Building Type of Construction: No. Bedrooms .......... a <br /> A t <br /> Addition .......... .................................................... Septic Tank Size Gals. <br /> Sanitary Size ft. x ft. '• <br /> Fillip /Gradin 4a. Absorption Field Site: <br /> Filling/Grading .......... Height............. Stories ............... 3 <br /> Moving Soil Type .................................... <br /> .......................................... s r <br /> o <br /> Mobile Home ,,,,,,,,,, Slope Fy : <br /> Privy Perc. Rate ................................. . <br /> .......... 3. Use (describe exactly, 1 -family >e <br /> Well .......... home,garage, motel, etc.) Dry Well .......... h �. <br /> Subdivision „ Seepage Trench .......... w <br /> Camping Unit Seep .......... <br /> See a e Bed .......... <br /> Location of proposed structures and existing structures,well,sewage systems, roads etc.,should be Seep <br /> 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- M a <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. w <br /> — -------------------------------------------- i o. <br /> 5. L.�ot/$�Ize: Fig. A. 6. Location: <br /> . ... ft. x ..7.:. ft. — ............ . ....... sq.ft. ............................................................................... i ElA <br /> Application for land Use (6 month period) <br /> Camping Permit from to <br /> date) date 0 <br /> Z <br /> O <br /> d <br /> N <br /> m C N < N m m <br /> aIE <br /> : W d 0 <br /> T < m c <br /> 0 h m D a m <br /> Z o 0 <br /> o i <br /> U <br /> D <br /> .......................................................... ........... <br /> ,J/.... p <br /> i o C <br /> Signature off lQwner`pr{Agent <br /> � G 1 ate X <br /> Remarks til..L.f/... Jul:!v.G.G.R.-.4y...l...EL.M4,S......r��...%!6-Ty..�......................................................................................... T � � m <br /> ............................................................. <br /> ............................................................................................................... ...... .................... . . ................... <br /> ° m — Nm <br /> Inspection Date ....................................... '7 /G�1Cv. ..a. ........... : 1° G' o a o v <br /> Zoning Adminis ato6 r . . 8 8 8 8 8 ai <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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />