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Burri County Office of Zoning Administratoro vo
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 0
<br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as < H
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c :�
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and re Mations of the State of Wisconsin. 3 nr�i
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT �
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<br /> ADDR�SS ADDRESS
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<br /> ADDRESS ADDRESS �W
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<br /> PHONE................................................................................ .PHONE................................................................................ V
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<br /> PLUMBER WELL DRILLER
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<br /> ADDRESS ADD.. RESS m
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<br /> ........ .................................................. P. . . NE. ................................................................................... » .`
<br /> PHONE HOZ
<br /> DESCRIPTION4. Sanitary Facilities: ° o °
<br /> 1. Work: 2. New Building Details No. Bathrooms
<br /> New Building .. .. Type of Construction: No. Bedrooms ... 'o
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<br /> Addition ......,,,,, .r-R�w.,-� ............ Septic Tank Size Gals. .......... <
<br /> Sanitary ....,,... Size .. ....t/ � ,)— ft. ...•'.•... `. ' n
<br /> v 'a 7 .... ft. x ........
<br /> Filling/Grading .......... Height............. Stori P s ............... 4a. Absorption Field Site:
<br /> Moving .......... Area ..�a.�. .f.�.. ............... Soil Type ...................... ............. �.
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<br /> Mobile Home ... Slope .......................................... © ? I
<br /> Privy . .. 3. Use (describe exactly, 1 -family Pere. Rate ...................................
<br /> Well home,garage, motel, etc.) Dry Well .......... sC 11
<br /> Subdivision ...,....., Seepage Trench ..........
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<br /> Camping Unit ,,,,,,,,,, Privy .......... �,
<br /> ------------- .................................................... Seepage Bed .......... p i ,.iVL
<br /> ------------- Cir rn
<br /> Location of proposed structures and existing structures well, sewage systems, roads etc., should be sketched in Fig- A- Include road t � �
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter-
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING
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<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. � -'
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<br /> 5. Lot Size: Fig. A. 6. Location: n :n
<br /> .14.0-0..... ft. x . ....0.. ft. - ............................... sq.ft. ..............................................................................
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<br /> Si^,t,.re er or Agent,, ,�,z Date o C
<br /> Remarks < � "`"�'•"�L- f-` . /•?Q 7 7 X In
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<br /> Inspection Date ....................................... .feT�llG6:V.. .<.... ...... E °o[ "' ' 8 o u m
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<br /> Zoning Ad Inistrator x J 8 8 8 8 8 8 0
<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.
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