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e7J 6"'o <br /> Burnett County Office of Zoning Administrator I; c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m' �• <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 n <br /> Burnett County Land Use Ordinance, Sa itation Code, and with a ther applicable County Ordinances and the laws and <br /> regul 'ons of the Stat fWis sin. 3, a <br /> � n .1........ ui.errz� .............. ........::. .. . ... � a �. . ..... <br /> �l�^ ............... a <br /> (please print) CO TR C R or URVE OR or GEN 1 <br /> OC..fJS.�1.................... Cis <br /> ... A��.,...I (e.... la...... <br /> ADDRE <br /> WE <br /> 531-70 ADDRESS . <br /> ADDRESS ADDRESS <br /> ................ <br /> ........................................................................................... . . . . ... <br /> ................................................................ <br /> PHONE PHONE <br /> ............................................................................................ '!�7 <br /> ........................................................................................... <br /> PLUMBER WELL DRILLER <br /> ................ <br /> ........................................................................................... .AD... .. .ES..... <br /> ... <br /> .............................. ......................... .� <br /> ADDRESS DR.. S <br /> n o <br /> . . . ................................................................................... . ................................................................................... 0 <• <br /> o' ` <br /> PHONE PHON........E ZN <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> i. Work: 2. New Building Details No. Bathrooms .......... 0 <br /> No. Bedrooms .......... llljj\�� <br /> New Building .. .. Type O s ructio Z <br /> AdditionSeptic Tank Size Gals. .......... <br /> .......... ........... .. . . <br /> Sanitary .......... Size .. .. .. ft. x .. .��...�T(..` ft. .......... i <br /> Filling/Grading .......... Height............. Stories ....I ....... 4a. Absorption Field Site: i <br /> Moving .......... Area ........................................... Soil Type ......................... ........ ? i r <br /> Mobile Home .......... Slope .......................................... <br /> Privy .......... 3. Use (describe exactly,'1 -family <br /> Perc. Rate ................................... m i <br /> Well .......... home,ge, o el etc.) Dry Well .......... T <br /> Subdivision <br /> .......... Seepage Trench .......... Z <br /> ........... `• ' ... ....... Q <br /> Camping Unit .......... .......... <br /> .................................................... PrivySeepage Bed 4-�-o i <br /> --------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. :-C- c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at :Q i <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. i o <br /> ______________________________________________________________________ ( i <br /> 5. Lot Size: Fig. A. 6. Location: :d, <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> i <br /> 0 <br /> o <br /> o' <br /> r <br /> 0 0 <br /> wee <br /> 9 <br /> Z G� <br /> ff0n <br /> u1 � <br /> v <br /> I m <br /> `4 <br /> JJ r/1 � NrD (om � <br /> "ao< : WC000F. <br /> O N . G . 0 0 f0 <br /> Z(y0 D 1 <br /> cn� Nn ' <br /> o 0 rT <br /> .......� l�Q............�G .�. .'�7 x P. G <br /> Signature o�S�er or Agent / Date o <br /> o <br /> N <br /> T . <br /> Remarks ......................................................................................................................................................................... m ;. <br /> m •• <br /> ........................................................................................................................................................................................ o o <br /> ............................................................................................................... ....................-P-7 : o . <br /> o . . <br /> . ............. . <br /> Inspection Date ....................................... . .. . . <br /> . . . . ... .... ........... . 'V ........ <br /> Zonin Administra r 8 8 5 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 />