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Burnett County Office of Zoning Administrator to M0 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 < N � <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m o <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a 6\ <br /> y� , Cr-trlsan/ <br /> J <br /> ............ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. � <br /> L3oA 337 a <br /> ................................................. <br /> ADDRESS ADDRESS -� <br /> ADDRESS ADDRESS <br /> ................................................. <br /> PHONE.................... .. ........................................................ .PHONE.............................. <br /> r.. . <br /> G W / l4- ISO Al <br /> PLUMBR .... <br /> ........................... <br /> ..... <br /> ................3^ .go.� WELL DRILLE.R................................................................... <br /> ............... <br /> ......................................................................... _. <br /> ADDRESS ADDRESS n o <br /> ............................... .................. O <br /> ........................................................................................... .......................................... . ri <br /> PHONE PHONE ZJ <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms • ••r n V o <br /> New Building No. Bedrooms ... ... a a <br /> .......... Type of Construction: � <br /> ................................................... Septic Tank Size Gals. /.R.4.� 3 � 7 <br /> Addition ,,,,,,,,,, h � < • <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... f <br /> Fillip (Gradin 4a. Absorption Field Site: iv <br /> 9 g .......... Height............. Stories ............... <br /> MovingSoil Type .................................... 3 I <br /> Area o <br /> Slope .......................................... Q <br /> Mobile Home .......... ' <br /> Privy Perc. Rate ..r� _3....................... su <br /> .......... 3. Use (describe exactly, 1 -family w <br /> . .. <br /> Well .......... home,garage, motel, etc.) Dry Well ....... <br /> Seepage Trench <br /> Subdivision .......... ../.... :s-.� �a.l.!'1.:�• .......... A <br /> {....... .. . <br /> Camping Unit .......... Privy .......... <br /> .................................................... Seepage Bed <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched in Fig A. Include road .cr <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING p <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> -- o <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> m <br /> n <br /> N O <br /> O J <br /> J <br /> O <br /> J <br /> T s' <br /> Z <br /> O <br /> d <br /> J <br /> C N 1 G N m N <br /> A6,a 4 < N -J- F <br /> N C N m <br /> Z o o n <br /> O J n m 3 <br /> in - _ <br /> w <br /> . . ........................................ ........ .. ..... .................. o c <br /> ige of Owner or Agent Date x <br /> m <br /> Remarks .............�....:.G..�.....�....f.'..:k..`......s................................................................................................................. <br /> . . . . . o <br /> rfl <br /> ........................................................................................................................................................................................ II <br /> .......................................C. ............................................................ .... ..................... .. .... . . . . . . <br /> I$ <br /> Inspection Date t` - m <br /> Zoning Administrator F ) 8 8 8 8 8 8 0) <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 be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbinq 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 be made without approval of the Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />