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Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> < - ° N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Usem ipy <br /> Ordinance, Sanitation Code, and with all other applicable County Ord antes and the laws and regulations of the State of Wisconsin. — a <br /> �. <br /> p ///})(� - n N m :N O <br /> �K { C71/�LEJI"U.LIc?.....�........r ' ' T <br /> . .g.C..........................I.............. ........... ......... ..�i1h..a...................... C <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> 3'71l........IiE.......................................................... ...W.tea... ..�tX .................................................... <br /> ADDRESS ADDRESS <br /> WN T s"S p <br /> ADDRESS ADDRESS <br /> .!.J . .`1 . : .`lD.`f` ................................................. ............................................................................................ <br /> PHONE PHONE <br /> ............................................ ..............................................................................._........... [ <br /> . . ................ <br /> PLUMBER WELL DRILLER (1 <br /> O <br /> ADDRESS ADDRESS n o <br /> 0 <br /> � <br /> ........................................................................................... ...PHON.... N'E.................................................................................. o <br /> PHONE z = J� <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1, Work: No. Bathrooms <br /> 2. New Building Details o <br /> New BuildingNo. Bedrooms .......... -0 <br /> .......... Type of Construction: A <br /> Addition .................................................... Septic Tank Size Gals. .......... <br /> )C... <br /> Sanitary „ ,,,,,,,, Size ft. x ft. ”"""" ' <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................I.................. :e o <br /> 3 <br /> Mobile Home $OPe .......................................... � .. <br /> F <br /> Privy ,......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... y <br /> Well .......... h me,garage, motel etc.) Dry Well '^ <br /> �J .......... <br /> Subdivision ,,,,,,,,,, - /qC'u�'y� J(f�Q[-F,� Seepage Trench <br /> .... .......... <br /> CampingUnit t .E PrivyO <br /> . ...................... <br /> .......... ................ .. ......A....................... H <br /> Seepage Bed .......... � <br /> ---------------------------------------------------------------------- <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- Cu <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. � O� <br /> ---------------------------------------------------------------- v i = <br /> N <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. .......................... .......A.K. ............................ . . <br /> ).a <br /> � N <br /> N m <br /> 49 N 3 s' <br /> O � 3 <br /> U/kK LRI<� o <br /> S 0 <br /> >< orvfe See Rtf ! \t� ?' <br /> oM iia` aLIf if. Ave 5e-b 1)0! <br /> K �effe� alx�1 <br /> J�'� <br /> Sp,1,,rq/ Jv .0 <br /> MZ <br /> C N c m <br /> m NJasuan <br /> D a m <br /> 2 O O n <br /> O = n n 3 <br /> qa a — _ <br /> G�o <br /> m <br /> .. ..... .... ... ' <br /> Si na r f Owner o ent Date <br /> X <br /> Remarks ............................................................................................................................................................................ T m <br /> CX ....17°.G�`aG.................................................................................... v <br /> II <br /> :a <br /> a. H <br /> Inspection Date ....................................... .. .......... . . u, u• o u,l for m <br /> T <br /> Zoning ministrator 8 8 8 8 8 8 rn <br /> NOTE: A preliminary site inspection must be r 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 budd- <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 />