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Burnett County Office of Zoning Administrator 3 CD o O/J <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT v' 3. o o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < y <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use mCD <br /> "�\ <br /> Ordinance, Sanitation Code and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ;7+' o O <br /> A <br /> 6 ... <br /> .. . ...................................... ................................................ <br /> ........!..................... <br /> OWNER ( lease print) CONTRACTOR or SURVEYOR or AGENT CCD <br /> -f- <br /> .. .......... ....... ' .." .�..n. .►u.P........D. <br /> ADDR <br /> ADDRESS <br /> A.6R.. ..L.�C�.1...(..1. ........ ...............?..3?'.Y.�... ..................................................................................... <br /> ADDRESS <br /> ADDRESS ' <br /> 3'1 <br /> P.H.ONE... .................................................................................. <br /> PHONE <br /> ........................................................................................... . ..................................................................................... <br /> PLUMBER WELL DRILLER : Z <br /> .�� <br /> .................................................................. ............................................... . .........C ... ............... <br /> ADDRESS ADDRESS <br /> y r J 0 o <br /> ................................................................................ ............................................................................................ o « <br /> PHONE PHONE z H r <br /> DESCRIPTION 4. Sanitary Facilities: C o 0 0 <br /> No. Bathrooms Jj v C <br /> 1. Work: 2. New Building Details """"" 0 <br /> New Building Type of nstruction No. Bedrooms ti :� L <br /> ►.r —` Septic Tank Size Gals. . V4 <br /> Addition / ................ `� .... ,S.0 �. `� <br /> Sanitary ( Size . .... ft. x ....� ...... ft. <br /> Filling 4a. Absorption Field Site: <br /> ......... Height............. Stories ............... <br /> Moving Area Soil Type .................................... �: :� r <br /> .......................................... <br /> Slope .......................................... <br /> Grading .......... �? <br /> Mobile Home 3. Use (describe exactly, 1 -famil Perc. Rate ................................... <br /> Privy home,garage, motel, etc. Dry Well 's <br /> Well Seepage Trench .......... i-- <br /> Privy <br /> Subdivision .......... .................................................... Seepage Bed <br /> �.�X yd <br /> � . <br /> ---------------------------------------------------------- <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road r 6 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- U, o <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING y• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. U} o <br /> ---------------------------------------------------------------------- <br /> c�+ <br /> 5. Lot Size: // Fig. A. <br /> ................ ft, x .............. ft. — .,...Lf..1P...!,C'...... sq.ft. <br /> CD <br /> Cn <br /> O <br /> to <br /> .S <br /> CD <br /> 1 <br /> z <br /> a <br /> CD C C l <br /> (D, PQ <br /> a s m L m <br /> * T. <br /> O O O <br /> O <br /> -. C p <br /> CD <br /> C <br /> Signat re of Ow//n�� or Agent^ Date T xCD m <br /> Remarks�� !. .. �� 4. � �„'` CD : o � C <br /> .....................................�.................................................................................................... <br /> ` ...� :....C. ..�,-,��........................................................................................................ <br /> ...........I.............................;..................................................................................... .......................................................... <br /> r <br /> Inspection Date ...I :....... :• ....` .^.. ....... o c�o m <br /> o: <br /> Zoning Administrator N <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. <br />