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Jurnett County Office of Zoning Administrator C - Z <br /> o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 � :y <br /> v �; <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseCD c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. CD <br /> a <br /> .......... ��'�F�......P` PQ. .....P1..�. ......... Vie. . ............... N <br /> ............... ............................................... sue. <br /> OWNER (please print) C�1TRACTOR or,S RVEYOR or AGENT Q j co <br /> [ � CJ �f <br /> �........... .. . .. ... ............. <br /> l�o. t.e...a......... x..... . ,. ..................... �i�. ...... . <br /> ADDRESS + � <br /> ADDRESS � <br /> ........... rvd.u.. ......:......................................... <br /> ADDRESS ADDRESS <br /> 7/ ...� ..�"'.....7 .. .................... <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER <br /> ....................................................................... . .....E"S"S"............................................................................ p '� <br /> ADDRESS AD..DRESS <br /> m 0 <br /> O <br /> PHONE PHONE <br /> z y r- <br /> DESCRIPTION 4. Sanitary Facilities: o <br /> 1. Work: 2. N No. Bathrooms New Building Details <br /> New Building No. Bedrooms .. ti.�.... Typ f Construction: � <br /> Addition ....... , •.....V/rirllt 42 Septic Tank Size Gals. <br /> Sanitary Size . ..y.. ft. xLA.(S?...... ft. <br /> Filling Height....,...... Stories ...�......... 4a. Absorption Field Site: <br /> Moving ......... Area .....�ilJ�. ..4.�.. ?.:........... Soil Type .. r <br /> Grading .......... Slope .......rX./. l-t.!✓ ...'irS�c= ; ° i <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) Dry Well <br /> Well .......... ..... G?. i!l..G. .....-ate...... Seepage Trench .......... <br /> Subdivision ` Privy <br /> .......R44C.K..�'�....I.t�. ' R.C�:mr.rf <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 � <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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. H' <br /> ---------------------------------------------- 0 <br /> 5. Lot Size: <br /> ft. x .............. ft. — .. .......... sq. ft. <br /> m <br /> w h <br /> o <br /> O <br /> 27 <br /> CD <br /> ---------------- <br /> CUB'!- GI' <br /> /DV M cn r- - cn <br /> � v :!- ID <br /> Z oo' `° <br /> _. o : <br /> iv m <br /> .�..r......... � .... ...%.� p <br /> Signat e of n r Agent Date ° <br /> -n x M <br /> m <br /> CD <br /> Remarks ............................................................................................................................................................................ CD <br /> ........................................................................................................................................................................................... <br /> .......................... I. ....•.......................................................................................................................................... <br /> Inspection Date- .ate t, tL4¢�s,,.. —` Ov� o cs, o cn o m <br /> / f ........ ... .......................... <br /> 00000M <br /> Zoning Administrator o 0 0 0 o t/) <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facditwr <br /> uefore 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, clo any plumbing or start any bulki- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> Nith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />