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<br /> Burnett County - .' - Office of Zoning Administrator _ g o 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT • 3 N.
<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as u,
<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. a
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT Q 94
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<br /> ADDRESS ADDRESS co
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<br /> ADDRESS ADDRESS -ND
<br /> PHONE PHONE [\
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<br /> PLUMBER (/ W LL DRILLER
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<br /> ADDRESS ADDRESS n O
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<br /> DESCRIPTION 4. Sanitary Facilities: ` ° o ,2,
<br /> 1. Work: 2. New Building Details No. Bathrooms o ki
<br /> New Building Type f Constwtion: No. Bedrooms 2- N
<br /> Addition . ./t" Septic Tank Size Gals.
<br /> Sanitary ...) Size ....7.-6 ... ft. x 41.0 ft.
<br /> Filling Height..r Stories / 4a. Absorption Field Site:
<br /> Moving Area /If'Li"- Soil Type a r
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<br /> Grading iP 9g- Slope
<br /> Mobile Home 3. escribe exactly, �fami Perc. Rate
<br /> Privy home./garage, motel, etc. —" Dry Well
<br /> Well t F .. 14 ,C,��/t Seepage Trench
<br /> Subdivision ( 4-9C Privy
<br /> Seepage Bed n�
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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- _a.V)
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING :.A
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. N \t
<br /> 5. Lit i Fig. A. 6. Loca ion: C
<br /> ..4 ft. x .?�40 ft. — ...7Z i.Q 0 sq.ft. .. �j '✓ I-,#
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<br /> Sig, ture of Owner o gent r Date
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<br /> Remarks mci, r
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<br /> Inspection Date (�(/ of 0 C o o cNi, r
<br /> Zoning Administrator o 0 0 0 • o C
<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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