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Burnett County Office of Zoning Administrator �� c o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� µ <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. <br /> rl .... ............................................ �....�.v...... .......... ' o <br /> p{�- <br /> VW:KLE R (please pant r/ CONTRACTOR or SURVEYO oW r AGENT a <br /> pp� - � <br /> . ... .......... ........ d.a!4:b,'/........ ............................................................................................ a <br /> ADDRESS ? ADDRESS <br /> a . ?... .. ..wi.....SY.. 9. 3........ .......... . . . <br /> ADDRESS .... ADDRESS............................................................................ :a <br /> ........................................................................................... ............................................................................................ \ <br /> PHONE ............................................................................... PHONE <br /> ............................................................................................ <br /> PLUMBER WELL DRILLER �\\ <br /> Q <br /> ADDRESS ADDRESS <br /> n o <br /> ........................................................................................... . ..................................................................................... O. <br /> PHONE PHO......NE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> No. Bedrooms <br /> New BuildingType <br /> .......... of •• ; <br /> Addition .................................................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> FlllinglGrading ,,.,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................... ............... Soil Type .................................... 'r <br /> i' <br /> Mobile Home .......... Slope ............................ ............. oo ; <br /> 3 <br /> Privy .......... 3. Use (describe exactly, 1 -family Pace. Rate ................................... <br /> Dry ; <br /> Well ...I...... home,garage, motel,etc.) Dr Well .......... F ; <br /> Subdivision .//... Seepage Trench .......... ;is ? i I <br /> Camping Unit ,,,,,,,,,, Privy .......... t* <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- <br /> 01 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If <br /> property is located at a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING o <br /> H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ------------------------------------------------------------------- <br /> . A. . <br /> 5. Lot Size: FigA6Location: �a� <br /> ................ ft. x .............. ft. — ............................... sq.ft. .............W'. ..... .!!l..��(..:3... ..8d.............. o <br /> v e p <br /> J L ' 0 <br /> 0 <br /> s <br /> ' m <br /> Z <br /> f G � <br /> 7J VIr M NW Z <br /> c <br /> tmi Q < F <br /> M. N p: <br /> a fJi c m <br /> Z op' . y n m <br /> o 9 o n <br /> rn <br /> Edo <br /> %4' � p <br /> ................................... ...... ..... ....................... o c <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... m <br /> r» <br /> :� II <br /> ..................................................................................................... <br /> 1 <br /> ........�........................................... I <br /> 8;o <br /> ', mInspection Date ....................................... o N�. T ............. <br /> Zoning Adminis rator ice <br /> en <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <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. <br />