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<br /> Burnett County Office of Zoning Administrator �A 0 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT .
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<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < v,
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<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a ivl :�'V
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m
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<br /> ADDRESS ADDRESS .* F
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<br /> ADDRESS Y ADDRESS Ai `
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<br /> .�.�..��................................................... wELL DRILLER �'�
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<br /> ADDRESS ADDRESS m
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<br /> PHONE PHONEDZ
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<br /> DESCRIPTION 4. Sanitary Facilities: u 00 0
<br /> 1. Wo k: 2. New P .ding Details No. Bathrooms .... .. 3 i o '
<br /> New Building ........ Type of Construction: No. Bedrooms p
<br /> Addition ,e&7LAe E— r7-0,9 ,A1 Septic Tank Size Gals. ...I...... ''; i
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<br /> Sanitary .......... Size ......sl.. ft. x .... ft. .......... A: :c
<br /> Filling/Grading ,,,,,,,,,, Height ....... >>ZO4a. Absorption Field Site:
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<br /> Moving .......... 74cea ................ .... ... ............ Soil Type .................................... r '2
<br /> .......... SU,LP,GGE •A 6`G+C W io
<br /> Mobile Home ... ' x 17 / Slope .......................................... .f, .. .fil
<br /> Perc. Rate ................................... t �'
<br /> Privy ......,,., 3. Use (describe exactly, 1 -family 1 ()
<br /> Well
<br /> .......... home,garage, motel, etc.) Dry Well .......... t+t f;
<br /> Subdivision .......... Seepage Trench ..........
<br /> ......L..... .Q..N.............................
<br /> Camping Unit
<br /> Privy .......... r
<br /> Seepage Bed0
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<br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include roadc
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<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property rs located at a highway inter- p �e-
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING C ��
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<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p
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<br /> 5. Lot Size: .5 Fig. A. 6. Loc tion: I� -
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<br /> Signature of Owner or Agent Date
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<br /> Remarks ......................................................................................................................................................................... m0
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<br /> InspectionDate ....................................... . .. . ... ..... .... .... ............tr ..... o: m
<br /> Zoni Administrator $ $ 8 8 y
<br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facili iUS
<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 Administratol .
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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