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Burnett County Office of Zoning Administrator u o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- i 6\ <br /> a n 04 <br /> Jerry.......Bown _ . • ..• ,•• r� <br /> . . r.............................................................. ............... <br /> ••... . . ........ . . . . ...................................... Y <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> 12,Australian Ave. re <br /> . . . . . .......... ........................................ . ...... . . .......................................................................4....... C re :C� <br /> ADDRESS ADDRESS <br /> m :Z <br /> Little..Canada.,.....M!?e.....5.5�.�.7..................... ............................................................................................ <br /> ADDRESS ADDRESS tp <br /> ........................................................................................... <br /> .PHONE. . . .................................................................................... '1 <br /> PHONE <br /> DonaldDaniels ................................................................. <br /> PLUMBER WELL DRILLER <br /> Box..W....Siren.e..W1.-......5?!$.7? <br /> ADDRESS .. .... � 1 � <br /> ADDRESS n^. o <br /> 7.t5-463.-23.33..................................................... ................................................................................ ...... <, <br /> 0 .. <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms ......1... �'.6� <br /> 2. New Building Details o <br /> New BuildingT No. Bedrooms !3 <br /> ,,........ Type of Construction: �������•• <br /> Addition ......4........................ Septic Tank Size Gals. 1006 v < w <br /> Sanitary ...X.... Size .............. ft. x ft. ""•'•"' <br /> Filling/Grading ....4..... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... AreaSoil Type ........................... <br /> Mobile Home Slope ........................... ........................ -•'. o <br /> • <br /> •• '�—. <br /> Privy 3. Use (describe exactly, 1 -family Pere. Rate 3,.min. / inch <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Seepage Trench <br /> Subdivision .......... .......family. home <br /> Camping Unit .......... Privy .......... v <br /> .................................................... <br /> Seepage Bed .......... q� �� <br /> ______________________________________________________________________ N ;Z <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road i C :£ <br /> on <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 /> 0 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> x <br /> 5. Lot Size: Fig. A. 6. Location: tl_ i :4 <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... 0 <br /> m <br /> 0 O <br /> J <br /> -01 <br /> � W <br /> S <br /> T <br /> m W <br /> Z <br /> O <br /> sasa <br /> w <br /> C d T W m N <br /> -O (Nit <. m d <br /> m m <br /> Z o D a <br /> o C, n ' <br /> p <br /> Signature of Owner or Agent Date — <br /> X M <br /> m <br /> Remarks ......................................................................................................................................................................... m„ ; p <br /> m <br /> ........................................................................................................................................................................................ II : : <br /> ....................................................................................................... ...... ./.�...A.............�i. ....... . Q.? <br /> Inspection Date ....................................... ./..:..../9 ..r I% 8 0 8 S iai 8 m <br /> O l ....... ..... .... ...................I. <br /> Zoning Administ for F� o o y <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 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 made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />