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Burnett County Office of Zoning Administrator �' o <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 nd p <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable ounty Ordinances and the laws nd <br /> regulations of the State of Wisconsin. p a 3� <br /> ..V..�.........��. .�. 3...R..c1...5...!.�.�3a .. . .. .......... ..... G� L n <br /> ........... <br /> OWNS (Please pr m) CONT AC OR or SURV R or AGENT (P <br /> ............. ... (7— <br /> .................................. cT <br /> r �� h .....�� ............................................... d <br /> A^DP RESS ) ADDRESS <br /> at� <br /> , F ...................... .. ........................................... ...... <br /> ADDRESS � ����rV� tJli Ilc ll ) `- <br /> ADDRESS <br /> x <br /> PHO/f� �„ Jj;IJ HONE - ' <br /> . .[ 1.. .................................................. ..................................................................................... ...... T <br /> PLUMBER VVV wELL DRILLER ,r.�x� : P� <br /> il� •� i - <br /> ........................................................................................... .A........ .RES.. ................................................................................ -. <br /> ADDRESS DDS o illy <br /> ;n <br /> 0 7 <br /> PHONE PHONE Z ,e r <br /> DESCRIPTION 4. Sanitary Facilities: P <br /> 1. Work: No. Bathrooms .. <br /> 2. New Building Details <br /> Now Building No. Bedrooms ..... <br /> .... Type of Constru tion: i <br /> /�Q�+ Septic Tank Size Gals. ..... '� <br /> Sanitary Size ...a.A., ft. x ...�. .... ft. '•�'� JS <br /> Q c�F 4a. Absorption Field Site: <br /> Filling/Grading .......... Height.....A...... Stories ..........f.... <br /> Moving .......... Area ..................... ..................... Soil Type ............................ ....... r <br /> MobileHomeSlope .................................. ....... <br /> .......... <br /> Privy 3. Use (describe exactly 1 •family Perc. Rate ........................... ....... W <br /> Dry Well 2 <br /> Well .......... home,garage,motel, at . " """' <br /> Seepage Trench o�:� <br /> Subdivision """ 1 r <br /> .......... .................................................... <br /> Camping Unit Privy„ ........ <br /> .................................................... <br /> Seepage Bed <br /> ----------------------------------------------------------------------- <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fi . A. C 6 <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is Iota d at i <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. v`-, <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O <br /> ----------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ...................................................................... ........ <br /> i5• � n <br /> N O <br /> O n <br /> 0 <br /> f <br /> ✓ T :� <br /> Z <br /> o <br /> 9 <br /> v <br /> n <br /> I` 71 fA � mrD ID co -0 <br /> m <br /> m moo.•c - nm _any <br /> O G dC N J 3 <br /> 0, •c p ,n m <br /> O : Y ' 1 <br /> o 0 ” 0 <br /> O <br /> ......... . .:................................. ............... x p` : my <br /> Au <br /> re of ner or Agent Date : g <br /> Remarks n <br /> ................................................................................................................................................................... ..... . <br /> o . o <br /> 0 0 <br /> ........................................................................................................... ...... ........ ............. ... ....... . ... T <br /> e N � NoouNi <br /> Inspection Date rmtt <br /> ZoningAdmini ratof �, SSS 8 S S W <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary f cilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app(cation 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 be 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 />