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Burnett County Office of Zoning Administratorm o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 :0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� in Z <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c .W <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. p- <br /> // t� ( L1 / 3 ��%......... r?,t A. . QLI....... C..h S.LC.! /..� a.....-.. W..C&11C 7 o <br /> OWNER Iplease print) CONTRACTOR or SURVEYOR or AGENT <br /> ADDRESS . ....... 12..........w ....................ADDRESS —a- <br /> 0 ,............: /-L.........�os9....................... .// <br /> ADDRESS ... . . . ....ESS.4..he-..'�......... ..........!. S.l.�:.../........................ <br /> AD RE <br /> /.Z.....�3.?<3...-.`.k.20............................................ rr — .,CC — 3311 � / <br /> PHONEPHONJ.]............57... ?>.........../s�.. 1.................................. �......... ...............� ..H ............ ........... X. � Irl.................................. <br /> I{ <br /> PLUMBER ] G • •• • i CN <br /> (� WELL DRILLER o <br /> ...................................... <br /> ADDRESS ....................................... <br /> ........................................ <br /> ADDRESS .................................................... <br /> •o <br /> PHONE 63S Po <br /> ~i <br /> DESCRIPTION z <br /> 4. Sanitary Facilities: g K <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building No. Bedrooms $ <br /> .......... Type of Construction: ... <br /> Addition .S£c.illa. ,,,, ! 1 Septic Tank Size Gals. 2SrJ <br /> Sanitary Size ...ZT.... ft. x .�.�. ft. <br /> .......... <br /> Filling/Grading Height............ Stprieg ..A-&-. .. 4a. Absorption Field Site: : '• <br /> ?j7rY�J <br /> Moving Area .....1j.... Soil T o•: <br /> .......... . ................ Type ................ ......� ' <br /> Mobile Home 3 : o <br /> .......... Slope ..................... <br /> Privy Perc. Rate .............. ......7.-1 ... F <br /> .......... 3. Use (describe exactly, 1 -family vC <br /> Well .......... home,gar e, mo I, etc. Dry Well <br /> Subdivision _ � Seepage Trench <br /> .......... <br /> Camping Unit ••• •••• � '" <br /> .. <br /> ...... <br /> .......... Privy t{ <br /> ------------ .... .. — .................................. Seepage Bed <br /> ---------------------------------------------- ........ �s €a <br /> Location of proposed structures and existing structures,well,sewage systems, roads, etc.,should be sketched in Fig A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- JJ: a <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. vl <br /> _: <br /> ----------------------------------------------- Oi <br /> ----------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. <br /> ts <br /> 0070 p3-- ", � <br /> e j t <br /> n a� <br /> 300+ ":>j <br /> O <br /> ►yo" �,,, b4�k a� �l�ID^"� s c <br /> 1 H� d <br /> n <br /> n 5 � <br /> all <br /> ..r/ ...` ate _ <br /> Owneror Agent "" """""""' CCe�Sturee <br /> ` X 70 <br /> ........... g <br /> .......... ...7 :ff..w..... �....6.c.......> �� ............................................................ 61 <br /> �tI� <br /> ................................................................................... _i. <br /> a TInspection Date ....................................... . . . . . . m <br /> .. 7�... <br /> ....I...... <br /> Zoning Administrator $ g g g g g y <br /> NOTE: A preliminary site inspection must be made nd 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 be marle without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />