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Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> O O <br /> TO THE ZONI-NG ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < <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 amend regulations offtthe State of Wisconsin. 3 0 <br /> OVYNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> �QJ a <br /> U.. .........../3.S'...................................................... ............ <br /> ADDRESS ADDRESS � <br /> < �{J' ,. �OZS . . . . . . ............................................................................... <br /> ADDRESS ADDRESS <br /> Y <br /> P NE PHONE <br /> ................. ........' ....................,....................................................................... <br /> PLUMBER WELL DRILLER <br /> .......................................................................... ESS .......................................................................... <br /> ADDRESS ADDR <br /> o <br /> ........................................................................................... o <br /> PHONE PHONE <br /> DESCRIPTION P H r A <br /> 4. Sanitary Facilities: ( ° o ° <br /> 1. Work: No. Bathrooms ° <br /> 2. New Budding Details 0 <br /> New Building ,(ti, „ No. Bedrooms .. <br /> Type onstruction: <br /> Addition ••,•• F— a w`,'� ,y Septic Tank Size Gals. .......... <br /> Sanitary ... Size ..� ...... ft. x .. ..7.•..• ft. � iep <br /> Filling .„•,,,..• Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........ Soil Type .................................... .r <br /> ............................... ... : <br /> CT <br /> Grading .......... .......................................... : <br /> .......... : <br /> Mobile Home 3. Use (describe exact) -famil Perc. Rate ................................... <br /> Privy home,garage,motel,etc.) Dry Well .......... :^ t <br /> Well .......... Seepage Trench 9n <br /> ~E <br /> SubdivisionPrivy <br /> .................................................... Seepage Bed <br /> ---------------------------------------------------------------------- <br /> '� N <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road O C <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 G <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ^� <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --- — ----- :b <br /> 5. �Q t Size: a l ��--77 ,! Fig. A. 6. Location: <br /> °5. .�.... ft. x ... ....... ft.— ....(.r..l.... .....!�sq.ft. ............................................................. ................ i <br /> .V1 <br /> br <br /> I <br /> o. <br /> J <br /> t <br /> 0 <br /> C' <br /> Z i <br /> 0 <br /> m <br /> m <br /> :12— <br /> �o C W W <br /> C N <br /> m. N a O_< C <br /> -O Ctl< C : i O <br /> Z O O <br /> O <br /> • fA � <br /> O <br /> ............. ,...` �.............. >..-..G...-.�'r�............... p <br /> . <br /> Signature of Owner or Agent to o C <br /> X <br /> Remark,j.' .LIGfJ...... ..1,�irr!r....�o�....�9��.7.................................................. i c <br /> L� -- <br /> vi • <br /> /D- may - s � ,� 00000 m <br /> P <br /> Inspection Date ...................................... <br /> ................................... o: 000000 <br /> Zoning A ministrator E e 0000000 <br /> VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> )efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> !his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ,vith 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 />