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Burnett Courl Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < „', � <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseM c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> ..[2.. ..r .. ......... ........LO 'Not . . .�1�A�ssel ....�+......s7 .tl.r .� N <br /> OWNER (please print) ” CONTRACTOR or SURVEYOR or AGENT m <br /> ea.9S.$/.4..Yo.....�A- ....... '�... a <br /> ADDSS� �r''S V� ADDRESS .° <br /> ................ ........................................................................................ A' E <br /> ADDRESS ADDRESS <br /> ........................................................................................... .PH....O.....E.................................................................................. <br /> PHONE n N � Epp i <br /> ,Y..GI. ...�C.1.... 114!.).A.A.A1.......................... <br /> PLUM R S WELL DRILLER E <br /> ADDRESS ADDRESS C) <br /> .....fB•,,. I•,7t^.�..... „I..,R. at <br /> ..7...................................... ............................................................................................ •� O O : <br /> PHONE PHONEZ n <br /> DESCRIPTION 4. Sanitary Facilities: 00 <br /> 0 <br /> 1. Work: 2. New Building Details No. Bathrooms 'V1 c <br /> New Building t Type of Construction: No. Bedrooms -o <br /> m <br /> Addition •„ „•,• .................................................... Septic Tank Size Gals. <br /> Sanitary ......`. Size . ft. x ...:3 ft. •••••• LJ <br /> Filling4a. Absorption Field Site: <br /> .......... Height...I........ Stories ............... <br /> Moving Soil Type ................... .... <br /> .......................................... 7..... : r- <br /> 0 <br /> Grading <br /> Grading Slope .......................L. ?. . . <br /> \ i <br /> ... ...... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................ .............�.... v E <br /> Privy .......... home,garage,motel, etc.) Dry Well E <br /> Well L- o <br /> Seepage Trench <br /> Subdivision Privy <br /> :- <br /> Seepage Bed X.... <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- <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. o- <br /> ------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: E <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> P <br /> Cn <br /> 0 <br /> n <br /> N o <br /> o <br /> 0 <br /> 0 <br /> s <br /> Lu <br /> L: TI \ <br /> fD <br /> Z <br /> O <br /> M <br /> m <br /> 7 <br /> N <br /> M cnry NCoZ <br /> C N " d <br /> m, Naas � ri ' � <br /> O'^.C 1 fG <br /> OZ 5 5 N fD <br /> • �' <br /> .................... .. . . . . ... a��a gag's/ w p <br /> Signature of ner or Agent Date <br /> X <br /> T m <br /> Remarks ......................................... 0i p <br /> 69 s: <br /> Inspection Date <br /> .y <br /> Zoning Admini trator ..F ............. c E coo 0 0 NJ <br /> VOTE: 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 /> ng 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 />