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Burnett County Office of Zoning Administrator be 71 o 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 H :� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lard Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisc nsin. 3 CL <br /> a ? <br /> L lrlq,e...y.......A4� 7,1111 G�o� , ��G S s i N , o <br /> ................ C n <br /> OWNER (please print) ONpTRACTOR or SU RVEVOR or AGENT m '� <br /> /..T. ... ......... ......... ......... 5..- g <br /> ADDRES� ��. I T / ADDRESS :� o <br /> .... ,T. <br /> 7 i <br /> ADDRESS ADDRESS <br /> 7 <br /> - PHONE PHONE <br /> ...... ........ <br /> ........................................................................................... .WEL........L..DRI........ ..LLER.. ..................................................... .. <br /> PLUMBER <br /> O <br /> ........................................................................................... .................................................................................. ......... ;Z N <br /> ADDRESS ADDRESS <br /> n o <br /> ........................................................................................... .................................................................................. ......... O .i <br /> PHONE PHONE _ <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms ......... i o <br /> New Building .......... Type of Co ctlon: No. Bedrooms ......... 0 <br /> Addition �5y M� Septic Tank Size Gals. ......... i ? \ <br /> ...r . ... ................../............................. .. <br /> Sanitary <br /> .......... Size .............. ft. x .............. ft. ......... <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .......................... ......... > r <br /> O <br /> MobileHome .......... ................................ ......... <br /> .......... i <br /> Privy ,......... 3. Use (describe exactly, 1 -family Perc. Rate ......................... ......... <br /> Well .......... home, arage, motel, etc.l Dry Well ......... <br /> /q- Seepage Trench90 <br /> �1 <br /> Subdivision .......... ......,�Olh6- """"' .I _ <br /> Camping Unit ,,,,,,,,,, Privy ......... <br /> .................................................... <br /> Seepage Bed ........ i <br /> --------------------------------------- — --------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Inclu e road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highwa inter- 1 �. <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. <br /> O <br /> ------------------------------------------------------------------- -- <br /> 5. Lot Size... ft. x .............. ft. . ............................... sq..ft. 6. location <br /> ...................................................... .......... <br /> P <br /> Aft <br /> N <br /> V� o <br /> 07 <br /> 0 <br /> W a <br /> ��UJ d o <br /> I � d <br /> 3 a' <br /> _ <br /> f�XIS7_, �KI_ �' wine, <br /> (6eJ sfi <br /> < <br /> C: <br /> < . . _ M <br /> /�( p Z o o a 70 <br /> o on <br /> o — <br /> ...... ..... ............... ....f.�.. p <br /> 0 <br /> Signature of wne/r or Agent Date �.i I, — <br /> Remarks ..............t " �au� L" -iC�t S�i Zn �� / JCAe ' m <br /> e....:.... . .............,.......o... . ................... .. ....,......1................................................... <br /> 0 <br /> .. <br /> X . . . <br /> ..............� .......Q. s .e.....57. ..�-�,.... e .. .......................5 .. ........................I.......... o <br /> ........... a L.Tr.-.s...>"........ ...... ................................................. .... .................. <br /> I <br /> a: -, <br /> Inspection Date m ~ m <br /> ....................................... ..... ..... .... . o : rn morn <br /> .. ............................................... <br /> Zoning inistrator <br /> NOTE: 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, it copy of the percGlatior test must be attached to <br /> this application before a permit will be issued. Do riot purchase or Install a septic tank, do any pit robing Or start any build- <br /> ing until a permit has been issued. A permit may be revoked If misrepresentation of any of the In ormation conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not tie made without approval of tie Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE .AND APPROVED. <br />