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CU/S F ce•tiz r4 12 '4 r"LZ <br /> .1s-n <br /> Burnett, ounty Office of Zoning Administrator D) CD 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 7.' 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '< H 2 O <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD 0 <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a fD <br /> '),qN 64,-y r kits Q , <br /> ADDRESS ADDRESS ' il.k v 0 <br /> ADDRESS ADDRESS A`? g."\ <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER (1) <br /> ADDRESS ADDRESS )J (� 0 0 <br /> F(16 — S26 0 S 0 < <br /> PHONE PHONE Z r ,^ <br /> DESCRIPTION 4. Sanitary Facilities: (7:4o o o ! <br /> 1. Work: 2. New Building Details No. Bathrooms ( 9� o <br /> New Building Type of Construction: No. Bedrooms c . <br /> Addition Septic Tank Size Gals. .'1. 3 \( <br /> Sanitary ...?(... Size ft. x ft. .-...t, <br /> Filling Height Stories 4a. Absorption Field Si s" (s <br /> 17 <br /> Moving Area Soil Type ... ', o <br /> Grading Slope .. - ` <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate <br /> Privy home,garage, motel, etc.) Dry Well t, <br /> Well Seepage Trench 0 <br /> Subdivision Privy <br /> Seepage Bed ..K -?t ..,P <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road C <br /> as <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- -C I a. <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING I k < <br /> H. <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. evi o' , <br /> SAI 3 f <br /> 5. Lot Size: Fig. A. \,r <br /> ft. x ft. — sq.ft. <br /> �� cCD <br /> o <br /> 0 <br /> N O <br /> o 3 <br /> 3 <br /> o t}- <br /> N <br /> ri H <br /> \1 ,' O <br /> N 3 <br /> 4 s <br /> -8. <br /> rt m t,. "(! <br /> T \` <br /> 11 z <br /> 0 <br /> si © m <br /> i m <br /> fj (^ <br /> IN <br /> go cnr -D m <br /> o 0 . c <br /> CD, N)0a< n- rZt' <br /> '+ 3 <br /> C <br /> Z 0 3' CD <br /> 0 --, — <br /> i t <br /> N <br /> 'va x lit'l . . �- • 5— r �8?— a c <br /> Signature of Owner o e Date g rr <br /> m r <br /> X <br /> Remarks CD EA Xi C <br /> {* _ •c <br /> v,�` II <br /> Inspection s/ ocno10 rr <br /> p Zoning Administrator o 0 0 o o U <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 />