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Burnett County Office of Zoning Administrator 7 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. , <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as m :W <br /> shown herein. T:e undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use E f0 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> �. �.... . .G. ..m.G.n. ....... . .a .. <br /> a <br /> ...................... � <br /> 0 <br /> OWNER (pleasseeoprintf UV J CONTRACTOR or SURVEYOR or AGENTCu <br /> m [ m <br /> .. ............................................................................................ <br /> ADDRESS <br /> ADDRESS m <br /> 7r <br /> ADDRESS �J ADDRESS <br /> J............................................. .PHON... ..............................,................................................. <br /> PHONE <br /> ........................................................................................... . .......................................................................................... <br /> PLUMBER WE LL DRILLER �E <br /> ........................................................................................... . .......................................................................................... � .o \ <br /> ADDRESS ADDRESS <br /> ........................................................................................... <br /> PHONEPHON..E................................................................................ .Z o <br /> DESCRIPTION <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> New Building ...... ... Type of Construction: No. Bedrooms .......... a \ <br /> Addition .................................................... Septic Tank Size Gals. .......... i < <br /> 4 <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading ..,..,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... i r— <br /> Mobile Home Slope .......................................... W o <br /> Privy ... .... 3. Use (describe exactly, 1 -family Perc. Rate .........................I......... <br /> Well .......... home,garage, motel, etc.) Dry Well I <br /> Subdivision Seepage Trench .......... J`% -41 <br /> .......... <br /> .................................................... <br /> Camping Unit ......... Privy .......... yj <br /> ------------ Seepage Bed .......... <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 property is located at a highway Inter- _r <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING f 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------------------------------------------- <br /> 5. <br /> ----------------------------------------- _ , <br /> ---------- <br /> 5. Lot Size: Fig. A. 6. Lo iion: <br /> ..� .G.... ft. x .. Qa. ft — .....390CJ'O s4. ft. ..3, <br /> G °....... . .. o <br /> ... 1' N►fly...................................... <br /> is <br /> N t!V1) <br /> m <br /> � or <br /> I 3 <br /> bl c, pri /o I <br /> Yexar � S�� percnla�lo� Yes f e�®f► t? `'� <br /> 0 <br /> v <br /> , <br /> n r v w m z <br /> �Q n <ME m o c m <br /> m N Ei <br /> < _ n <br /> Z o g Dam <br /> �J 0 <br /> o : <br /> igs nature of net or Agent Date ° <br /> � 17 <br /> Remarks ................................................... X <br /> ...................................................................................................................... m m <br /> v <br /> ................................................................................................................................................................................. <br /> ............................................................................................................... ... ............. <br /> Inspection Date '•' $ N m <br /> ....................................... ... . ........ ... .... ..................................... <br /> Mm <br /> Zoning A it �E $ $ $ S $ Vt <br /> NOTE: A preliminary site inspection must be made an 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 A Iministratot. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />