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Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT µ' 3 <br /> N <br /> ' y <br /> < - <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 Land Use m m <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3. a <br /> o <br /> .............. . .......................................................................................... a <br /> m <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> liU.... �' Y <br /> ... ........................... <br /> . . ....................... . <br /> .1� s <br /> ADDRE.SS. . ADDRESS a <br /> S..S...-&f 4.,�(................. ............................................................................................ <br /> ADDRESS ADDRESS <br /> (-I;1, SE/ � 5 3v <br /> PH E PHONE U <br /> /e ......... ....................................................................................I....... v <br /> PLUMBER �J�" WELL DRILLER .� <br /> .. .. .. �....W./..5. .o <br /> ................................................ . .......................................................................................... :o ', <br /> ADDRESS ADDRESS M <br /> :V 0 <br /> ........................................ . ......... <br /> ................................................................................. <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: r�'0 o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o � <br /> New Building .......... Type of Construction: No. Bedrooms .......... a ',�• <br /> ,SR c ark Si Gals. / . .. <br /> Addition .......... ..ize ............................................ LlGP��� � S. <br /> � .. �'i0 < <br /> Sanitary .... Size .............. ft. x .............. ft. <br /> // C /R/ <i.0 E <br /> Filling .......... Height............. Stories ............... 4a. Absor ti Field Site: <br /> Soil Type .................................... �. <br /> Moving .......... Area .......................................... 0' 0 <br /> g Slope .......................................... ua .� <br /> Gradin .......... I <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... .t <br /> Privyhome,garage,motel, etc.) Dry Well .......... <br /> Well <br /> "" 9 9 <br /> Seepage Trench .......... <br /> .......... .................................................... W <br /> Privy .......... <br /> Subdivision <br /> .......... .................................................... Seepage Bed .......... <br /> ----------------- {1 .N !� <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road Q <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 /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> W <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p o <br /> -------------------------------- ------------ - 61 n <br /> 5. Lot Size: Fig. A. 4. <br /> ................ ft. x .............. ft. — ............................... sq.ft. <br /> M <br /> 0 <br /> p ij :W <br /> o <br /> (A <br /> ?S o <br /> ,JP <br /> i it <br /> / N� h <br /> 00 <br /> f " / • <br /> / � m m <br /> T Nan< m �' R1 <br /> z op'm « 3 <br /> N <br /> 31) O y <br /> Signature of Owner o ant Date <br /> m X Rf <br /> Remarks 0 <br /> (1 <br /> . ................... <br /> . .. ........... <br /> .................................................................................................. <br /> �O_ <br /> T <br /> Inspection Date ....................................... ............... ooyastr.a.tor. <br /> ZoninAm <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary eel to <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must bK,o thri/rt <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any Plumbing or';"" U here <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the informatl�VfOstrator_ <br /> with is found to exist. Changes in plans or specifications shall not tie made without approval of the Zr <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE A^ <br />