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, J ) <br /> Burnett County Office of Zoning Administrator c <br /> APPLICATION FOR SANITARY - LAND USE - BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described Ind 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he w £ <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws Ind <br /> regulations of the St4t@ of Wisc nsinXt� » :! <br /> h / Q <br /> .... .!............... ... A G ..... ............... .......................�.'....(... .................................... ..... 1"^ e........ ...OWNER (prl�ease priCONTRACTOR or SURVEVOR ar AGENTADDRE S ADDRESS��. .".. ¢ til . . �ADDRESS - ADDRESS............ . .. ......................a�/�... ...��.. ......................................... PHONE <br /> ... ...y { .. . ... <br /> ER ...... . .... ..............ADDRESS CPHONE PHONENrjDESC 4. Sanitary Facilities: ° 6 <br /> 1. Work: No. Bathrooms ........ 0 <br /> 2. New Building Details ' � o <br /> New Building Type of Construction: No. Bedrooms <br /> •• ""' <br /> Addition ...... `,°;''' Septic Tank Size Gals. .. .. <br /> Sanitary Size ..d.`.k..... ft. x ...-3.� <br /> ..�..• ... ft. �' •••••• <br /> 4a. Absorption Field Site: <br /> Filling/Grading ,,,,,,,,., Height............. Stories ............... : <br /> Moving .......... Area Soil Type ............................. ...... cr <br /> Moblla <br /> i <br /> HomeSIOPe ................................... ...... <br /> y Perc. Rate ............................ ...... m <br /> Priv 3. Use (describe exactly -family <br /> Well f- <br /> wali .......... home,garage, motel,etc.) Dry We ... mZ •,f <br /> Subdivision Seepage Trench ... ...... o ^: <br /> .......... .....................I.............................. N <br /> Privy <br /> —_Camping Unit— .......... .................................................... <br /> Seepage Bed <br /> --------------------------------------------------------- -- .� N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at ' ,I <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection, <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :C) 0 <br /> ___________________________________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ....................._............................................. ..... <br /> 5 � <br /> n <br /> : t ^ <br /> N � :N o <br /> o r J <br /> p <br /> e o a <br /> f <br /> nI � <br /> ®r-e ",Oil- <br /> ar <br /> T' v <br /> to �. <br /> fU 3b m p"a� '— nm max <br /> •Z� O 8 rn� � � p � m ; <br /> D <br /> O 2 rn <br /> » 0 O <br /> m <br /> <, �.f•.4.r•4 F % v ........ /C.l....... ...... O : p� : m <br /> ...... .l.. . .:... .. .�.. ................ <br /> Si nature of�Ojwner or Agent Date $ <br /> Remark ..../.... �. .�....................................................................................................................................... .... a <br /> H <br /> ........................................................................................................... ....... ................... ......... .......................i.... <br /> In <br /> ../ ..... N ONOJN m <br /> Inspection Date .1... a.�............................. g . .......... .... m <br /> Zoning Admi trator 8 8 8 8 N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app)cation before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has beer issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />