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Burnett County Office of Zoning Administrator <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 9n <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulationsof the State of Wiscoinsi n. g <br /> ).!ha....iz J.. O <br /> ti Q <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> ... ......:1.e........... c X.....!:?.. ................. ...................... ..................................................................... — ; <br /> a <br /> ADDRESS I ADDRESS m ' ' •� � <br /> ..�W... .... ....-R ...........W......!..................................... . . . . . . ............................................................................... [ � <br /> ADDRESS t ADDRESS <br /> ........................................................(C.....�. ............................ <br /> PHONE PHONE <br /> ��..� �:. .. ...f.�...s.............................................. ............................................................................................ : l <br /> 0.0 <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS m 0 <br /> F <br /> 0 < :6\ <br /> . . . ................................................................................... ........NE.......................................... <br /> . ........... <br /> ................. <br /> ........... <br /> :Z :r6 <br /> PHONE PHO <br /> DESCRIPTION 4. SanitaryFacilities: <br /> h <br /> Batrooms <br /> 1. Work: 2. New Building Details No. •• ••• .,� ' <br /> Type of—Construction: No. Bedrooms <br /> New Building .../ .. .... <br /> Addition „ `� Septic Tank Size Gals. <br /> Sanitary Size .'.' ft. x ...:3..4:... ft. I <br /> •.�... <br /> FIIIInglGrading ,......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... <br /> ........................................... <br /> Mobile Home _-.._-._.. Slope .......................................... v i <br /> .......... i <br /> Perc. Rate ................................... m � <br /> Privy .,........ 3. Use (describe exactl�:1�fami—lyy� c <br /> Well ,......... home,garage, motel,etC.l Dry Well .......... n,, <br /> SubdivisionSeePa9 e Trench .......... o n <br /> Camping Unit .......... .................................................... Privy :7 <br /> Seepage Bed -, <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. : c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located 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. �j 0� <br /> ______________________________________________________________________ (It <br /> 5. Lot Size: Fig. A. 6. Location: ! <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... l <br /> o <br /> r z » <br /> o <br /> d, <br /> X � f <br /> te' <br /> a <br /> lo�� <br /> Z------------ <br /> Z <br /> ,6 _ <br /> cnvvr Dm W y <br /> 5 IS U <br /> �tAesl Cw1a.� (� WbtN y <br /> W�(� be CL61e T-- S''I" <br /> t a <br /> � ' c <br /> .... ...Is-,� �.................................... ....-'.l 1 .� ..... x p m <br /> Signature of Owner or Agent Date <br /> Remarks ............. <br /> �-s �, m(.(.... ............ .1�` !!......................................................................................................................... <br /> ............................................................................................................ ................... ........................................ <br /> Inspection Date �.�y......�.7......... .... 1 •..-�.X.WI.IA. � o <br /> T <br /> .. . .--Zo...... ... . . N V7 O N <br /> N <br /> Zoning Administ fort 8 $ <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <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 />