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Burnett County Office of Zoning Administrator �' c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT NO <br /> N 3 _ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 0 t� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 1 <br /> Q. <br /> ' .........................I. ±!/ <br /> �1NER �I Pr nt �J�!..................... �1�.✓.1 �i.E./.... .Z.�..S................ �" <br /> '' <br /> regulationso the tat of Wiscon n. <br /> CONTRACTOR or SURVEYOR or AGENT <br /> < G <br /> ADDRESS j j ADDRESS ..........................................I..... m <br /> l( 00 . <br /> �.:........................................I ^^t�� <br /> ADDRESS ADDRESS <br /> 7 a..�....� 1 I...... <br /> V . .NEPHONE <br /> ............................................................................... ¢ <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... <br /> ADDRESS 'A"D"'DRESS..................................................................... <br /> m G1 <br /> C < <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms ...J...... e <br /> Hew BuildingNo. Bedrooms j <br /> Type of Construction: R U� <br /> .......... de.1 fqi AA>\� <br /> Addition K -.,.,jV,,, F ,pe'K Septic Tank Size Gals. ... <br /> .......... t.. ... ......... �...... <br /> Sanitary Size ....i. ...... ft. x ... ....... ft. J....•. <br /> FIIIInp/Oredlnp .._....... Height............. Stories ............... <br /> 4a. Absorption Field Site: <br /> Moving Area Soil Type .............................�...... i c <br /> Mobile Home Slope ................................... ...... v » <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ............................ ...... o <br /> Well .......... home,garage, motel,etc.) Dry Well ... ...... i <br /> Subdivision ,,,,,,,,,, Seepage Trench Z <br /> .................................................... - <br /> Camping Unit .......... Privy ... ...... <br /> .................................................... Seepage Bed <br /> -------------- ----- -------- — ------ -------------- -- <br /> — <br /> — -- — — -- — <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig44 A. .JI.J c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is IocatQd at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> -------- -- ---------------J-- I <br /> -- O <br /> 5. Lot Size: Fig. A. 6. Location: � <br /> ................ ft. x .............. ft. — ............................... sq. ft. ........................................................................L..... <br /> s <br /> �'�y <br /> I I o <br /> I ° <br /> _ I W <br /> o <br /> 37 (nv (prD W m -0 <br /> �/ <br /> J Na . 9 <br /> ..10a <br /> 'c m <br /> J. L . ''FC ........................... ........... �..'. .7......... x A m <br /> Signatu a of Owner. or{agent Date o <br /> VV o , <br /> ur ; <br /> Remarks .....................................................................................................................................................................{... <br /> .......................... <br /> ............................................................................................................ .. ...................J1j(/✓t.`/ . ................................. <br /> Pe .4 ..... .. T <br /> Inspection Date ....................................... ........ . . .. . .. t� .. .. �....L., N U 0 O O N m <br /> Zoning Administrate_ I/ 8 8 8 8 8 fA <br /> NOTE: A preliminary site inspection must be made and site approV granted on all structures involving sanitary fac Iities before constructi <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />