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ON Comp\ i
<br /> Burnett County Office of Zoning Administratorv 0 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 N
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a VI \ ��
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<br /> O,W[NNRlplease print) L L CONTRACTORor SURVEYOR or AGENT c
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<br /> A' ES ADDRESS
<br /> ��OW ��� ..lN.l... �Y..4.a.Y.................. . . . . . ................................................................................. - »\
<br /> ADDRESS ADDRESS
<br /> PHONE................................................................................ .PHONE................................................................................
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<br /> PLUMBER . ..........................................................................................
<br /> WELL DRILLER
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<br /> ADDRESS . ...... . .............................................................................. O
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<br /> ........................................................................................... . .PHON. . ..E.................................................................................. :Z 0
<br /> PHONE
<br /> DESCRIPTION 4. Sanitary Facilities: ° o 0
<br /> 1. Work: 2. New Building Details No. Bathrooms
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<br /> New Building .......... Type of Construction: No. Bedrooms .......... 0
<br /> Addition .......... .................................................... Septic Tank Size Gals. .......... <
<br /> Sanitary .......... Size .............. ft. x ft. ..........
<br /> Riiiingl Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site:
<br /> Moving Soil Type ................
<br /> .......... ........................................... .................... n r
<br /> Mobile Home Slope .............................. ........... o
<br /> .........
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<br /> 3
<br /> Privy ,,,,,,,,,, 3. Use (describe exactly, 1 -family Perc. Rate ................................... �
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<br /> F
<br /> Well ,,,,,,,,,, home,garage,motel, etc.) Dry Well
<br /> .....••.••
<br /> Subdivision , ,,,,,,,, See a e Trench
<br /> .......... R ;ill
<br /> Camping Unit .......... .................................................... Privy ..........
<br /> Seepage Bed .......... V
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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_
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. T.
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<br /> 5. Lot Size: Fig. A. 6. Location: \,
<br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... ts
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<br /> Signature of Owner or Agent Date ° C
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<br /> Remarks ...:..................................................................................................................................................................... T rr
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<br /> ......Inspection Date ....................................... Qi
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<br /> Zoning mi strator k�
<br /> 8 8 8 8 8 8 a
<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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