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Burnett County Office of Zoning Adminis rator d 0 0
<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 roc ted as
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Lad Use m c :J
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wls onsin. a
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m to
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<br /> ADDRES. ADDRESS
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<br /> ADDRESS ADDRESS
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<br /> PHONE..............Q...�!'...f;?... ... ..`.?�.U.�........................... .PHONE................................................................................ E
<br /> PLUMBER WELL DRILLER �^
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<br /> ADDRESS ..DR.....ESS,
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<br /> PHONE ...................................................v....................................... o .
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<br /> DESCRIPTION o
<br /> 4. Sanitary Facilities: � o
<br /> 1. Work: 2. New Building Details No. Bathrooms
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<br /> New Building Type of Construction:
<br /> No. Bedrooms .......... a
<br /> Addition .......... .....Ps.L/�.... Si C!1.................... .. Septic Tank Size Gals. ..........
<br /> Sanitary ,,,,,,,, Size ... ft. x ...s .7... ft
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<br /> Filling/Grading Height....—. Stories ...../......., 4a. Absorption Field Site: i
<br /> Moving .......... Area Soil Type ..........................I......... 3
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<br /> Mobile Home Slope ..................................... °
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<br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ..........................I........
<br /> Well .....,,,,, home,garage, motel, etc.) Dry Well .......... F!
<br /> Subdivision ,,,,,,,, Q r. Seepage Trench ..........
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<br /> Camping Unit Privy ..........
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<br /> Seepage Bed ..........
<br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc, should be sketched in Fe A. Inclu e road t
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property s located at a hlghwe inter- G o-
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection- CLEARLY LABEL EXI TING
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONSa
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<br /> 5. Lot Size: _ Fig. A. 6. Location:
<br /> /..a.R... ft. x ft. — ......... sq. ft.
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<br /> Signature of matter gen
<br /> Agent Date o : C
<br /> Remarks .................. ...... m x O
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<br /> Inspection Date ....................................... jJ .. .... .... . ...... .. . ..... .. ..... i o' um, u
<br /> /I Zoning Admin rator g o 0 0 0
<br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involviny sanitary facilitl
<br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attacher) to
<br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any budd-
<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 8,ND APPROVED.
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