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Burnett County __ Office of Zoning Administrator C M 0 0 <br /> _APPLICATION FOR SANITARY = LAD USE — BUILDING PERMIT <br /> '- 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as �7 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use i= <br /> m <br /> Ordinance, Sanitation Code, and with all other pplicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> O <br /> ..... ........ ........... �..................... . .... ..6'N.F. A. .............................................................................. c _° <br /> OWNE lease print) I, ! CONTRACTOR or SURVEYOR or AGENT a <br /> 0 <br /> A <br /> DRES <br /> S <br /> ADDRESS <br /> j�N{,,.v../.✓.r.""r.'.................. ........ .................................. . .......................................................................................... I! I\1 <br /> ADDRESS .. ADDRESS <br /> ...............................-......................................................... ............................................................................................ <br /> PHONE PHONE <br /> .......... <br /> ........................................................................................... . . ....... ................................................................... <br /> r <br /> PLUMBER WELL.. .. DRI.. 'Ll, �=�-- <br /> 1 <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS m G7 <br /> < <br /> ....................... ............................................................. ............................................................................................ o' "l <br /> PHONE PHONE <br /> z 0 <br /> o ° ' <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> DESCRIPTION 4. Sanitary Facilities: °.......... o <br /> New Building Type construction: NO. Bedrooms .......... <br /> Addition ,,,,,,,,,,,, ,,,rJ(-c(m�- Septic Tank Size Gals. .......... <br /> Sanitary Size Q ft. X ........ ft. """"" <br /> Filling/Grading .......... Height$J{J/...... Stories ...f.......... 4a. Absorption Field Site: - <br /> "��yy ......... .. .......... Soil Type .................................... � m <br /> Moving .......... Area ........75. .0........... ° <br /> Mobile Home .......... ... . $°Pe .......................................... .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,gara e, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench ........ p <br /> .......... 'o ..... Privy <br /> Camping Unit <br /> .......... ...-v .-..�. .. .`n.E.r............ Seepage Bed i <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should he 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 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING J o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ac- <br /> ---------------------------------------------------------------------_ <br /> I <br /> 5. Lot Size: Fig. A. 6. Location: C3 <br /> ................ ft. x .............. ft. . ............................... sq. ft. .............................................................................., <br /> i <br /> t � � <br /> 'o'LL T <br /> 0 <br /> C <br /> `S �C_ <br /> I -Fyfit�IC� <br /> tor � � mm <br /> ' _ <br /> C 0aa <br /> c m <br /> ti Z O N n <br /> O Zea <br /> O. <br /> be <br /> o <br /> O � <br /> p <br /> ...:::...... . <br /> .......... <br /> ........... .�,t . 3. <br /> Signature Owner or Agent Date — <br /> _ _ _----- <br /> Remarks ......... ............... ....................... ..I..... - ...... ... .......... T 0 <br /> ......... . .. ... <br /> �e � ��.. ... ... .......... <br /> m <br /> �r� <br /> .......................................................................................................... ...................:. ..:.. ...;........... .................... <br /> n <br /> Inspection Date ....................................... t t11QJ...S,.:...;.!..`......�. <br /> Zoning Adrn1 trator% 1..V S S S s o s <br /> NOTE: A preliminary site inspection must be made and site approval granted ori all structures involving sanitary (acilitii4- <br /> before construction can begin. In the case of seweraye disposal systems,i,a copy of the percolation test most be attached to <br /> this application before a permit will be issued. Do not purchase or Instal d septic tank, do any plumbing or start any bLJdd- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed he,(- <br /> with <br /> erewith is found to exist. Changes in plans or specifications shall not be mate without approval of the Zoning Administratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPEc rD BY THIS OFFICE AND APPROVED. <br /> 1 <br /> i <br /> t <br />