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Burnett County Office of Zoning Administrator (ae o o <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 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 <br /> m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a �r <br /> v <br /> -T w N d o <br /> u!.� .9..N..... ► . a.!'....1.....I.............................. ..... . . . .......................................................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> L1 m <br /> 5:. a.r........ .:fi......�5r....y.. . ...L .................. ............................................................................................ d c� <br /> ADDRESS ADDRESS <br /> S ... ..�..N. i u.1.,.............................................. .................................................................................. r <br /> !� ........ . <br /> ADDRESS ADDRESS <br /> Il Nyea <br /> 1 W <br /> PHO ............................................ PHONE <br /> ........ ...... ........................... . . . ..................................................................................... <br /> PLU BER WELL DRILLER <br /> O <br /> ADDRESS ADDRESS m C <br /> 5........................................................................................... .....PHONE....................................................................................... <br /> PHONE <br /> Z r <br /> DESCRIPTION 4. Sanitary Facilities ° o <br /> 1, Work: No. Bathrooms <br /> 2. New Building Details r <br /> o <br /> New Building ,�- Typof Eonstruction: No. Bedrooms <br /> Addition •I �"� Septic Tank Size Gals. .......... <br /> ...... ... ..... .......... .... ............ ............... :J <br /> . .... ........ ft. ......... <br /> Sanitary ,,, Size ..1.�:..... ft. x ... <br /> �� 5 <br /> Filling[Grading .......• Height............. Stories ............... 4a. Absorption Field Site: '. <br /> g Soil Type .................................... o <br /> Moving .......... Area ........................... ............... <br /> Mobile Home .X... Slope .......................................... <br /> Privy .•.......• 3. Use (describe exactl 1 -famil Perc. Rate ................................... <br /> Dry Well s" <br /> Well .......... home,garage, motel, etc. <br /> Subdivision ......... .................................................... Seepage Trench .......... <br /> Camping Unit Privy i <br /> i�Xa <br /> __-------------------------__---_-----_—__—_—__—____ Seepage Bed_---_—____—_y xj <br /> N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should he sketched in Fig. A. 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- W I <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. p <br /> 5. Lot Size: � �dd Fig. A. 6. Location: i <br /> ................ ft. x .............. ft. — ..lL...r.T..�.�t..5....... sq.ft. ..................... ........................ i k� <br /> Rd G <br /> - - N O <br /> o � <br /> O <br /> c <br /> ev <br /> Ir <br /> z <br /> \ � J <br /> / �G <br /> ^� N rs� Z <br /> n W <br /> c � <br /> (r _ Z 05 D a m <br /> ( O � a� 3 <br /> VA <br /> , FA _ <br /> � �\O m <br /> c)r/ice J//�) �m m <br /> ... .. j`�.. '. ./.!: ........ ...................................... ��_. . -� o m <br /> Sicc teat e o Owner o, ent Date `:fes,^ — <br /> ,(/ X : JJ <br /> Remarks (V A-� ... ?f". ::f.:............................................................................................................................ M : . . . . m <br /> O <br /> ................................. 4.: .... ............................................................................................. <br /> ............................................................................................................ .... ............ %"r.................................................. <br /> 'spection Date <br /> N �7............. <br /> MM <br /> .. oZoning Administrator <br /> V7 <br /> ,de A preliminary site inspection must be made and site approval granted on all StrucLureS involving sanitary facilitwo <br /> 'xs`'nstruction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> M9 ,bion before a permit will be issued. Do riot purchase or install a septic tank, do any plumbing or start any build- <br /> �sN xmit has been Issued. A permit may be revoked if misrepresentation of any of the information conveyed here <br /> - <br /> o exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> "TEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />