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Burnett County Office of Zoning Administrator Q 1 o 0 <br /> APP61CATION FORSANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as � <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a p9\ <br /> ................ ....... . . ................... <br /> OWNER (please print) ' CONTRACTOR or SURVEYOR or AGENT n s <br /> m <br /> lb'f9... . ................................ ............................................................................................ a <br /> ADDRESS ADDRESS •+ <br /> /I m <br /> ADDRESS ADDRESS <br /> ....f..... ` .... .7. Li..�............................... ...................................................................................I........ <br /> PHONE PHONE <br /> .......... <br /> ........................................................................................... 'V'VIE L........DR...I.L...LER............................................................... <br /> PLUMBER L <br /> O �1 <br /> ........................................................................................... ............................................................................................ —. <br /> ADDRESS ADDRESS io 0 <br /> n o <br /> .............. <br /> ........................................................................................... .............................................................................. <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: 2. New Building Details No. Bathrooms .......... i o <br /> New Building ........., Type of Construction: No. Bedrooms .......... ^ a .� <br /> Addition .,....,,.. ,,,,,,.............................................. Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: E i <br /> Moving .......... Area ........................................... <br /> Soil Type .................................... r i <br /> Mobile Home Slope .......................................... <br /> o <br /> Privy ..K.... 3. Use (describe exactly, 1 -family O <br /> Pere. Rate ................................... <br /> Well .......... home, garage, motel, etc.) Dry Well .......... <br /> SubdivisionSeepage Trench .......... t <br /> Camping Unit .......... .. . ................ Privy .......... <br /> "' Seepage Bed Y; <br /> —__------ --_ � <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> W <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property Is located at a highway inter <br /> < , <br /> section, show the intersecting highways and the setbacks required along them and at the intersection- CLEAR LV LABEL EXISTING V;� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i p� <br /> ----------------------------------------- ---------------------------- <br /> 5. Lot Size: Fig. A. 6. Lo ation: <br /> ................ ft. x .............. ft. — ............................... s4. ft. .. ..............7.....(f 41S.........�/.r.0..�:.... ......... <br /> N o' <br /> Q o <br /> y o E <br /> O <br /> Z <br /> O <br /> N <br /> Xs <br /> m <br /> G1 <br /> N r 9 n m Z <br /> n cr < c m <br /> F <br /> ro. N d <br /> an < F •� m c <br /> M <br /> z oo a ,'- 7o <br /> o a o <br /> on — <br /> o . <br /> � rn <br /> E <br /> An"AL�.... .... ate" o � <br /> mSignature of Owner t Date — <br /> X � <br /> m <br /> Remarks ......................................................................................................................................................................... m.� � � <br /> ........................................................................................................................................................................................ IV II <br /> yt <br /> : : <br /> Inspection Date ....................................... 1...".....r.. ............ ....... ......J.......... 1� " ? N m <br /> U U O T <br /> Zoning Admini trator /C 8 8980000 <br /> NOTE: A prelim/nary 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, 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 build- <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 lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />