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Wis. Furl <br /> Burneiri County Office of Zoning Administrator IP 'T <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 93. <br /> » M <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the n <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 `d <br /> reg las ions of the St teof Wisconsin �p <br /> e tl <br /> if rC .......................................... ........................................................................ >n A <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> 4 <br /> ................ ............................................................................ <br /> ADDRESS ADDRESS » <br /> W.S �/ , 11' <br /> AD DRE........ ..... ..........................:�... .Gf ........................ .ADDRESS............................................................................ <br /> ��ss r , <br /> CP S_............`............................................. <br /> ........................................................................................... n � <br /> PHONE PHONE <br /> .�5..........ki� .ey.PPr.................................... �0 7— <br /> PLUMBER WELL DRILLER................................................................... <br /> ............................... <br /> ADDRE ADDRESS n G :(? <br /> -c � ... » <br /> PHONE PHONE Z N ~ <br /> DESCRIPTION 4. SanitaryFacilities: c� ° o »r <br /> No. Bathrooms v <br /> i. Work: 2. New Building Details ......... c <br /> New Building ...,,.. .. Type f Construction: No. Bedrooms ..s:�Z..... <br /> NN Septic Tan Size»Galls. �� i•. i <br /> Addition .. A... ...... :!^.'.: ......2............... �k'.f . i <br /> Sanitary .. .... Size ...If.... ft. x ...../....... ft. �. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area . . .................. .. Soil Type ........q. ........................ i o <br /> Mobile Home Slope ........c7.f..ft..... ... . <br /> .......... ' <br /> Privy .,,,,,,,,, 3. Use (describe exa '1 -faml Perc. Rate .... ..:.�:' ............ m <br /> Well .......... hom , ara e,motel, etc.) Dry Well .......... m f� <br /> Seepage Trench ' <br /> Subdivision .......... """"" o <br /> ....... .. ...................... Privy <br /> Camping Unit '•••••'••• } <br /> Seepage Bed <br /> ---------------------------------------- --------- .- �� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. :-� c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at r- <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. C� <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 4D � o �,^ <br /> ______________________________________________________________________ ✓r <br /> 5. Lot Size: Fig. A. 6. Location: <br /> �.� .... ft. x'aSlfl.... ft. . ............................... sq.ft. ............................................................................... <br /> N O <br /> O (� J <br /> J y <br /> See A acSd— <br /> Z <br /> ro to <br /> [ rfit € t <br /> D Envcor- > W co y <br /> m c m mJ 00 c c <br /> m <br /> m Na•< — o. m aa � <br /> v < d c y J 3 <br /> D ' 1 <br /> a : y <br /> n 0 p <br /> m c <br /> I / o <br /> 2 �5........1� Q .f' ?E ................ ..�E'.`..g ...... <br /> n <br /> In <br /> Signature of Owner or Agent Date o <br /> Remarks m v, <br /> U <br /> ........................................................................................................................................................................................ <br /> ...................................................................................................................... <br /> . ................................................................ N N O N T <br /> Inspection Date ....................................... rn N N m <br /> Zoning AdmiZr, . T1 Vl <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be 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 /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator, <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />