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<br /> Burnett County Office of Zoning Administrator o 0
<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 < — o Aj
<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 0. :l ,.
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<br /> OWNER IPI s�ri in CONTRACTOR or SURVEYOR or AGENT m
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<br /> ADDR . ADDRESS ...
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<br /> PLUMBER WELL DRILLER T
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<br /> ADDRESS A..DD.. R..ES..S
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<br /> DESCRIPTION4. Sanitary Facilities: ° o °
<br /> 1. Work: No. Bathrooms
<br /> 2. New Building Details """"" o V '�
<br /> New Building „ ,:..... Type of Con(7strue n: No. Bedrooms .......... \
<br /> Addition G✓DG ... ........... Septic Tank Size Gals. .......... '
<br /> .......... ............ ....
<br /> Sanitary
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<br /> .......... Size . ft. x ..- a.. . ft. .......... i
<br /> yy� 4a. Absorption Field Site:
<br /> PillingtGrad Ing ,..,.,,,,, Height...lF........ Storles ...�........ p U:n .
<br /> Moving .......... Area .................. ........................ Soil Type .................................... .y.
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<br /> Mobile Home Slope .......................................... b
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<br /> Privy ,,,,,,,,,, 3. Use (describe exactly, 1 -family Pere. Rate ................................... � y
<br /> Well .......... home, arage, motel, etc.) Dry Well ..........
<br /> Subdivision ,,,,,,,,,, ��/f'/gQ t Seepage Trench ..........
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<br /> Camping Unit .......... Privy .......... O Q
<br /> .................................................... Seepage Bed
<br /> .......... 31
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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
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter o n
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING C
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0
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<br /> 5. Loy§�lzei,_,.., Fig. A. 6. Location:
<br /> ....... ...... ft. x .............. ft. — ............................... sq.ft. ...............................................................................
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<br /> Signature of Owner or Agent Date
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<br /> Remarks /.. Q. ErwFc /..��ta��t�....4t���! 0
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<br /> Inspection Date . . .. .. ...... ............................ 1011 o N 'o U m
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<br /> Zoning Adminis ator 8 8 8 8 8 8 co
<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 lie 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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