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077 CL7g
<br /> Burnett County Office of Zoning Administrator T o 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. y
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<br /> TO 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 m c
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 M
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<br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT a
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<br /> ADDRESS ADDRESS
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<br /> ADDRESS ADDRESS 1�
<br /> PHONE PHONE
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<br /> PLUMBER WE LL DRI LLER
<br /> ADDRESS ADDRESS
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<br /> DESCRIPTION0
<br /> 4. Sanitary Facilities: P °
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<br /> 1. Work: 2. New Building Details No. Bathrooms ..........
<br /> New Building .,, Type of�Cgqgqstruc�on: No. Bedrooms ..........
<br /> Addition ,,,,,,,,,, ,,,,,,,,, ,Wo.ov ..........
<br /> Septic Tank Size Gals. .......... o
<br /> yr Z......
<br /> Sanitary .......... Size ..?e.......... ft. x ..�r.fJ.p....... ft.
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<br /> Filling/Grading ,,,,,,,,,, Height.1.2...... Stories ............... 4a. Absorption Field Site: ice\
<br /> Moving .......... Area ...................... Soil Type ....................................
<br /> ..................... 'K p
<br /> Mobile Home .......... Slope .......................................... 3 '+
<br /> Privy .......... 3. Use (descri a exactly, 1 -family Perc. Rate ................................... Qi
<br /> Well .......... home !rage, otel, etc.) Dry Well .......... �.
<br /> Subdivision Seepage Trench ..........
<br /> Camping Unit .......... .................................................... Privy W
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<br /> Seepage Bed .......... i
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<br /> Location of
<br /> proposed structures #d existi g structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road
<br /> setback, side and back yard dim nsion an location and setback from all bodies of water. If property is located at a highway inter- C a
<br /> section, show the intersecting hi hways an the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING
<br /> STRUCTURES AND PROPOSE STRUC URES AND ADDITIONS. y-` o
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<br /> 5. Lot Size: Fig. A. 6. Location: o
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<br /> Signat?'of Owner Agent Dat. e: s.....
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<br /> Remarks ......................................................................................................................................................................... m m
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<br /> Inspection Date ....................................... .��.-..t,GCetJ E tli U '0 8 0 m
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<br /> Zoning Admin trator 8999990
<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.
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