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<br /> Burnett County Office of Zoning Administrator 0 a, o o y
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT v g. '
<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application-for a Permit for the work described and located as ' o� y -* (,1
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a ^
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a `7•. m
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<br /> ADDRES ADDRESS m * %
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<br /> DRESS — 1/../ ca-sr ADDRESS ,ADDR
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<br /> PHONE PHONE
<br /> PLUMBER WELL DRILLER
<br /> ADDRESS ADDRESS o o
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<br /> PHONE PHONE z •
<br /> DESCRIPTION 4. Sanitary Facilities: ° o g
<br /> 1. Work: 2. New Building Details No. Bathrooms r� o
<br /> New Building Type of Construction: No. Bedrooms cy, CD
<br /> Addition Septic Tank Size Gals.
<br /> Sanitary Size ft. x ft. r '�
<br /> Filling Height Stories 4a. Absorption Field t �•)
<br /> Moving Area Soil Type !SS� `Md
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<br /> Grading Slope rt r7f 0 °
<br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate
<br /> Privy home,garage, motel, etc.) Dry Well
<br /> Well , Seepage Trench O
<br /> Subdivision Privy
<br /> Seepage Bed
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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 t, a K
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- "V yL
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING \N
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 1 0 N
<br /> 5. Lot Size: / �I �np� Fig. A. 6. Location: roj (�
<br /> 336 ft. x ..3QU ft. — ...1C �T` .�.. sq.ft. ivy'
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<br /> m/nei-ors-- q,-1— 41.7%."-- 4..).3.- ,E.- t.-
<br /> Signature of Owner or Agent Date
<br /> Remarks '514 / /0,5 Vg �` m
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<br /> Inspection Date 000000m
<br /> Zoning Admi istrator KJ o 0 0 0 0 o N
<br /> 4OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities
<br /> iefore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to
<br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build-
<br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here-
<br /> vith 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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