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Burnett County Office of Zoning Administrator on - 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and to fated as o <br /> iqj <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. 3 Cu <br /> Ra men�..� .. iv.&a...P .l an. ........ Su�e� ..,...1-1 e .k�... ..ass ....... <br /> . .... ....... ............ .. <br /> OWNE (please print) TRACTOR or SURV EVOR or AGENT a m <br /> ............................. ,L 1 .I.. / <br /> AD RESS J ADD ..4. ....Cx:.f....!: :v.M.......' .7............. .......... a ;I ` >✓ <br /> .:.. .c�....... 5�"1CXQ................... .St. 0Co,.X...ralos. .1.1�1 .......�fQd. . ...... i <br /> a <br /> ADDRESS r ADDRESS y p <br /> ........................................................................................... <br /> PHONE PHON..E..............................'..l.v. ..T.. ..�... i� <br /> .. . <br /> ......... <br /> ........................................................................................... , <br /> PLUMBER . . .......................................................................... .......... �v 1 <br /> ..... . . . ............................................................................... WELL DRILLER <br /> ADDRESS . ............................................................................... .......... � <br /> ADDRESS �' G7 <br /> ........................................................................................... � <br /> n o <br /> ...................................................Y............................ .......... <br /> PHONE PHONE Z <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Construction: No. Bedrooms ....... Z <br /> Addition ....................... „. Septic Tank Size Gals. ....... I <br /> .......... ........................ ... <br /> Sanitary .......... Size .............. ft. x ft. .......... <br /> .............. O. <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type ......................... .......... <br /> .......... ........................................... <br /> Mobile Homei r <br /> Slope <br /> ............................... .......... <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pero. Rate ........................ .......... <br /> Well v home,garage, motel, etc.) Dry Well .......... <br /> subdivision .................................................... Seepage Trench .......... <br /> Camping Unit ,,,,,,,, Privy .......... <br /> .. ........................................ <br /> ------- ------ ------------------- -------Seepage Bed .. ....... <br /> — -- I <br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc., should be sketched In Fig_ Arn <br /> _ Inclu e road e <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highwa inter- _� a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL I TING <br /> p <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. d ixf o' <br /> ------------------------------------------------ ----------------- --- f <br /> 5. Lot Size: Fig. A. 6. Location: O 0 <br /> ................ ft. x .............. ft. — ............................... sq.ft. rs- <br /> .................................................................... .......... <br /> gacn�V <br /> < <br /> CS <br /> N <br /> Volb <br /> V <br /> o W a <br /> n <br /> 0 <br /> o � <br /> 77 rno mmZ <br /> C d <, � C N <br /> No — < —' F <br /> I in <br /> b y a m <br /> Z o i' n 7J <br /> m <br /> O <br /> A <br /> p <br /> §ig'i..................................................................... ...................................... o C <br /> Signature of Owner or Agent Date <br /> X �o <br /> Remarks .................................................................................................................................................................. ...... C <br /> .................................................................. :�: : <br /> Inspection Date ....................................... I ... .. .. �.. L U o o u m <br /> ... ..... . . ..:............... . tT. ... ...... <br /> (l� Zoning AdministVator S S S S S S Emit <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures IIIvolving sanitary facllitlas <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test most 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 tie made without approval of e Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE IFAND APPROVED. <br />