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<br /> 3urnett County Office of Zoning Administrator � - o
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT3
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<br /> 10 THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co c
<br /> Jr ' nce, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a
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<br /> DW ER (please print) 1 CONTRACTOR or SURVEYOR or AGENT co co
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<br /> 4DDRESS ADDRESS
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<br /> PLUMBER WELL DRILLER s�
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<br /> ADDRESS ADDRESS co n o
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<br /> DESCRIPTION 4. Sanitary Facilities: oo °
<br /> 1. Work: 2. New Building Details No. Bathrooms L
<br /> New Building Type of Construction: No. Bedrooms m
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<br /> Addition Septic Tank Size Gals. <
<br /> Sanitary Size ft. x ft.
<br /> Filling/Grading Height Stories 4a. Absorption Field Site:
<br /> Moving Area Soil Type rt
<br /> Mobile Home Slope
<br /> Rate
<br /> Privy 3. Use (describe exactly, 1 -family Perc. c.,^4Well .. ..., home,garage, motel, etc.) Dry Well
<br /> Subdivision Seepage Trench 1 z
<br /> Camping Unit Privy c/'1 �� t
<br /> Seepage Bed W
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<br /> Location of proposed structures and existing structures,well, sewage systems,roads,etc.,should be sketched in Fig. A. Include road -t a '
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 1 '
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING t�
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<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. SZ. 5
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<br /> 5. Lot Size: Fig. A. 6. Location:
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<br /> ft. x ft. — sq.ft. O
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<br /> Signat e of Owner or Agent Date
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<br /> Remarks m n
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<br /> Inspection Date - j e o
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<br /> Zoning Admin : rator 8 8 8 0 8 0 0
<br /> NOTE: A preliminary site inspection must be mad and site approval granted on all structures involving sanitary qcilities
<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 Administrator.
<br /> SEWER SYSTEM SHALL NOT -BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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