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Burnett County Office of Zoning Administrator a 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 N µ ,� <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 o- <br /> "YI as <br /> r�,1� ........ ............ .. 1))....m. �Ly��-............ ..................I. .. F <br /> OWNER (please print) CONTRACTOR or SURVEYOR ooA/ GENT 3. <br /> ......................................................... t�1 ....1 �.......s.yy .............................. d <br /> ....... <br /> ADDRESS ADDRESS � <br /> ADDRESS ADDRESS............................................................................. .\ <br /> PHONE PHONE g� g <br /> .......... <br /> ............................................................................ WEL. . . ..L...DRIlLL. ''' ..LER............................................................. G <br /> PLUMBER <br /> p <br /> ........................................................................................... .ADDRESS. 'D'D"iE"S.............................................................................. <br /> ADDRESS m C) <br /> ........................................................................................... ...................................................Y....................................... o ,`.• <br /> PHONE PHONE Z H � <br /> DESCRIPTION 4. Sanitar Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathroomso <br /> New BuildingType of Construction: No. Bedrooms .......... <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Fillingt Grading .....I.... Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving Soil Type .................................... r <br /> g .......... Area ........................................... � ° <br /> Mobile Home .......... Slope ...............................I.......... 0 <br /> Privy .......... 3. Use (describe exactly, 1 -family being. Rate ................................... <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... <br /> .......... <br /> .......... ................................................I... <br /> Camping Unit Privy .......... <br /> .................................................... <br /> Seepage Bed .......... <br /> go <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc.,should be sketched In Fig_ A. Include road Q <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 c <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o' <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. .............................................................................. Ust <br /> , <br /> 0 <br /> �ev <br /> 00 <br /> Ce <br /> 6 <br /> Z <br /> O <br /> D \ N <br /> 7 r t m m Z <br /> xa <br /> on <br /> _ _ F <br /> n <br /> Z o o D a <br /> O a � <br /> :R� 70 <br /> o <br /> ............e' of........er'o'... 'g'e' ................................. ................ ..................... o c <br /> Signature of Owner or Agent Date <br /> X � <br /> Remarks ......................................................................................................................................................................... :tr m <br /> v <br /> II <br /> ......................................................................................................... . ................................. <br /> pD .................................. p <br /> Inspection Date ....................................... �, ..CLC ...... �-(� i tl � ,uNi cNn o u o a m <br /> .. ..... ........... .. . ....................... 0 0 0 0 <br /> Zoning Admi'histrator �J . . $ o o $ o o V) <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 />