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Burnett County Office of Zoning Administrator d 0 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 /> N <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> Bob Albrecht <br /> .............. qp <br /> OWNER (please print) CONTRACTOR o'r SURVEYOR or, AGENT a V fr <br /> Rt. .. Box 197A <br /> .......... a <br /> ....... . ....RESS............................................................................. � <br /> ADDADDRESS = N <br /> Frederic, WI 54837 p <br /> ......... ................................................................................. .AD.. D......R...ES................................................................................ <br /> ADDRESS S <br /> .. ......653-2669....... 9 <br /> ........................................................ ............................................................................................ <br /> PHONE PHONE .or <br /> Donald Daniels <br /> PU.MR „ WLDR v I; <br /> UB <br /> I LLER <br /> Box..w..............Siren,...WI.....5.".Z?................... ............................................................................................ v� v <br /> R <br /> ADDRESS ADDRESS m LD <br /> .........463-233.3............................................................... ............................................................................................ a <br /> PHONE PHONE ZH <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •"'.I"" o p <br /> New Building Type of Construction: No. Bedrooms ....2... <br /> Addition .................................................... Septic Tank Size Gals. ..7515. <br /> Sanitary .......... <br /> ....x... Size .............. ft. x .............. ft. <br /> FillinglGrading „......•. Height........... Stories ............... 4a. Absorption Field Site: �? � <br /> Moving .......... Area ........................................... Soil Type .................................... i r <br /> Mobile Home .......... .................................... .... :n .. <br /> .......... :O <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .............................3.... � <br /> Well ,,,,,.,.,, home,garage, motel, etc.) Dry Well .......... � ;Ct w <br /> Subdivision .......... Seepage Trench .......... <br /> .................................................... <br /> Camping Unit Privy .......... <br /> .......... .................................................... I <br /> Seepage Bed '( <br /> x.... o <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> a <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter � fl- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> Ct <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. i :O o <br /> ________________________________________________ O� Z <br /> :� <br /> 5. Lot Size: Fig. A. 6. Location: t' o W <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... :M <br /> � ar <br /> a rn <br /> m <br /> N R° O <br /> O t <br /> See Attached 5 :O w <br /> o :nv <br /> r <br /> 0 <br /> J <br /> r00: a <br /> T W <br /> z <br /> z <br /> o <br /> v <br /> Sn <br /> m <br /> J <br /> JJ VI r- 9 N M Z <br /> o ` yam <br /> Z o o' n <br /> o nro 3 <br /> Signature of Owner or Agent Date <br /> Remarks �,.l:.� .' . <br /> . ............................................................................................................................................ m . <br /> ...................,.. .,,.............................................................................................................................................................. — <br /> ........................ .. ............. .. . .......................................... .;t E <br /> Inspection Date .. '.�.:�. ........ ...... . ..... , ° o $ o�o m <br /> ... ............................................ I\572/o . <br /> Zoni Administrator $ $ $ o $ y <br /> NOTE: A preliminary site inspection must tie 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 Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />