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01?( -)!I <br /> Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 7p�' <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < ._, 0 EOC) <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> &ci.1..:an ...( ar.�ene....1 �.r .. .. .. .......... .... ........ .... ... .... . .... ............................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .. . ..�.I.-...�.1.' ll. .'...✓.- R.1G..ID! LhJ,............................ ............................................................................................ a r� <br /> AD RES ADDRESS °: <br /> m ro <br /> ADDRESS ADDRESS i i I i <br /> (QQ–. 1.-. .�i7...................................... ............................................................................................ <br /> PHONE PHONE <br /> .......... <br /> ........................................................................................... .WEL........L..D..R..I..LLE.. R.. ............................................................. <br /> PLUMBER <br /> ADDRESS ADDRESSo ;� <br /> PHONE PHONE <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms v QJ <br /> 2. New Building Details o <br /> New BuildingT No. Bedrooms 1c 1 <br /> .......... ype of Construction: .......... ^ ,1 <br /> P: <br /> Addition ,,....,,,. Septic Tank Size Gals. .......... p � <br /> Sanitary ,,,,,,,,,, Size ft. x ft. ...••.•• • <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: (fig <br /> Area Soil Type .................................... 7 <br /> Moving ........................................... <br /> Slope <br /> Mobile Home .......... .......................................... : .+ <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... \ <br /> Subdivision Seepage Trench .......... Vv <br /> Camping Unit ... .................................................... Privy .......... 91 <br /> Seepage Bed <br /> -------------------------------------------------- <br /> ------------ p/n <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include roadInter- Z <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property 3 located at a highway ".I 0- <br /> section, <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. I 0 <br /> ---------------------- _------------ --____--------_---------_----- ----- <br /> 5. Lot Size: 'I•� ' I�,,,� Fig. A. 6. Location: nd1 <br /> ....�.�, .... ft. X . ........ ft. — ..Tutt-f. sq. ft. ............................................................................... <br /> ase, CArn�l i�/Wf �e�m��" o <br /> n 3 <br /> 0 <br /> H <br /> 1nI11YI <br /> \ T <br /> Z <br /> O <br /> N <br /> s <br /> m <br /> M V1rv � vrmz <br /> 0 <br /> a cn < C ' ,� <br /> Z c 'O <br /> - m <br /> O o D <br /> n 370 <br /> �0 O —1 <br /> Signature <br /> ..................... <br /> .... .......�.�.... ...................................... i � o � p <br /> Signature o pvvrp or Agent_ I ^,� Date q� ��,,./ <br /> Remarks ../1.-/.Q Q71e /..... t^(Y11....�..!..!CC�.not ....�I�....I�q�.C1.zo.............................................. - o <br /> X -: : : <br /> ....�reu..ec........Gtrr,d'.....l �S� . ...6�.. . .... fim :nc( . .1.1.X99.�..loa —.................... <br /> ....p(I...#113r-:�CQ.......................................................... .. ................... . ............. " <br /> T <br /> NN � � vm <br /> Inspection Date ....................................... ... .R.............. . . u m o o u, m <br /> Zoning Administr t r � g o 0 0 0 o y <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, a copy of the percolation test must he 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 hertz <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 />