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Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described avid <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the # i <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> reg,u�ka�tions of the State of Wisconsin. �, n <br /> 'IGAGI1 s &CrG� lQ/L Pr t t rC� — <br /> � ........................ .... ....... ..................�i.. .sf.................�'v.n. = . <br /> OWNqE�Fi�p�lea�x print) � CONTRACTOR r SURVEYOR or A NT <br /> S•'rC rl .t <br /> ADDRESS ADDRESS = � ?� <br /> ADDRESS <br /> ADDRESS <br /> ......... ................................................................................. ..........................................2................. ....................... ... oo <br /> PHOjJE PHONE i] Q.S <br /> Ij\/n>x....... .a. ,.,:-...1.s............................................... ................................................................................ .... <br /> PLUMBER WELL DRILLER ) <br /> ...5 i:. .e..t.......................................................... ... ...... . .......................................................................... .... <br /> 9 <br /> ADDRESS ADDRESSG a <br /> ........................................................................................... ....................................................................................... .... 3 .r.• <br /> PHONE PHONE Z r. r <br /> DESCRIPTION 4. Sanitary Facilities: ° o - <br /> No. Bathrooms -0 <br /> 1. Work: 2. New Building Details ... "" Q o i <br /> New Building No. Bedrooms i0 1 <br /> ,.,x„ Typepf Construction: '""' "" <br /> Addition '(.. ....... .d.-4IrL.............. Septic Tank Size Gals. ?L <br /> Sanitary .. K... Size .. 2. .... ft. x .. ... ft. ""' '•" <br /> Filling/Grading .......... 4a. Absorption Field Site: . <br /> ,,,,,,,,.. Height........... Stories . ..I....... <br /> Soil TVPe ............................... .... r i <br /> Moving .......... Area ........1.1rt:•. : o <br /> ...: <br /> Mobile HomeSlope ..................................... .... <br /> .......... <br /> Privy .......... 3. Use (describe exactly,'! •family <br /> Perc. Rate .............................. .... <br /> Well <br /> Well home,garage, motel,etc.) DrSeepage Trench ""'y ""' "" — <br /> .......... <br /> Z <br /> Subdivision .......... ` C� r � "" ' <br /> ./.p0.hl�....w.R .. .. 4. .e <br /> Camping Unit ......... ./ Privy 1 . <br /> """' Q. <br /> Seepage Bed RMS I <br /> ----- — rn <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is locate at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i 0 <br /> ______ _ . <br /> 5. Lot Size: Fig. A. 6. Location: j <br /> ................ fiA .............. ft. — ............................... sq.ft. ......................................................................... ..... <br /> N <br /> 63 :c <br /> » � f <br /> vks <br /> Lq <br /> \ o <br /> 11r N for � x <br /> v <br /> } 75 / <br /> M invrnr > cow "o <br /> M c M. m m 0 c c <br /> 0 ' cr < = o o — n1 <br /> Z o > 1 <br /> -/.y.:.. .7.... x <br /> � ei6 oo <br /> — <br /> inature of Owner or A t Date <br /> N <br /> Remarks <br /> ...................................................................................................... .... ....................1.... . .......................... <br /> .., n <br /> J N0DN, 88NRI <br /> Inspection Date ....................................... !. . aye ...... . 8 8 8 8 8 8 m <br /> Zoning Admini ator <br /> NOTE: A preliminary site inspection must be made and site ap oval 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 E pecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AP ROVED. <br />