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<br /> Burnett County Office of Zoning Administrator V] iTI 31
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<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT
<br /> TO TI-IF ZONING ADMINISTRATOR 11a ' ••. . - .iie•eby makes application or •e , , ' il i ,-ii,ir described and located as " (7,-
<br /> sicawn herein.The undersigned agrees that ail-mild ii.d lie done in accordance with the,OrlUire,,ie,its or the Burnett County Land Use , , N
<br /> Ordinance,Sanitation Code and ail oth -nplicabie County Ordinances and the laws and regulations of the State of Wisconsin i 7,-- k\
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<br /> OWNER(please rintr COtITRAC;OR orr6aURVEY0i or 91GENT,,,,,_
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<br /> ADDRESS I ADDRESS
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<br /> PHONE PHONE ;441
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<br /> PLUMBER WELL ORR LER P1i/
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<br /> ADDRESS ADDRESS ii 0
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<br /> DESCRIPTION 4. Sanitary Facilities: 9 ii 9.
<br /> 1. Work: 2. New Building Details No.Bathrooms (
<br /> New Building __Type of Copstt ucuran: No.Bedrooms -g ?\,
<br /> Addition 1.7' til* fer SS X>64.1/.44... EC.) Septic Tank Size Gals. 44°ei
<br /> Sanitary Size trio ft.x if,3 ft.
<br /> Filling Height Stories 4a. Absorption Field Site:
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<br /> Moving Area Soil Type
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<br /> Mobile Home 3 Use (describe exactly 1 -family Perc.Rate -...
<br /> Privy home,garage,motel,etc. Dry Well ).1
<br /> Well Seepage Trench t
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<br /> Subdivision Privy IQ
<br /> Seepage Bed Ifs
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<br /> location of pmclosed s,10,:mres and foisting A11:1 1,rinse ii,Surewn,W sy,tems,itJaCIS.M.,ShOlitC1 be sketched in rig.A Include load I
<br /> setback,side and back yard da-nenstori and location and setback Irofn all bodies of waler if property is located at a highway inter
<br /> section,show the irds.,:ttig highways and the setbacks iegoired along them arid at the intersection CLEARLY LABEL EXISTING Fi. :
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS . 0
<br /> 5. Lot Size: Fig. A. 6. Location: c7r
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<br /> Signatupt of Owner r Agent Date —
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<br /> Remarks
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<br /> Inspection Date ;Ff.,ey if.
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<br /> Zoning Administr or ZoTri0 o oo o 07
<br /> NOTE: A preliminaiy site inspection must lie 111 atit.: UOld ON, approval wanted ran ail sliuctuies involving sanitary famliti.
<br /> before consttuction can begin. In the case of siiwei age disposal system,, a copy (0 the percolation test wrist Iii' altar hed ti
<br /> this application before a pet in it will lie issued Do not put chJse or install a septic tank,do airy plumbing 01 start any build
<br /> ing until a perm it has been issued. A pen mit may be !evoked if m isi ago tisentation of any of the 11110101 a tion conveyed Irene
<br /> with is found to exist. Changes in plans or specifications shall riot he made withool approval of the Zoning Ailnitiostialril
<br /> SEWER SYSTEM SHAt t NOT BE COVERED UNTIL INSPt CTED BY THIS OFFICE AND APPROVED
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