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Burnett County Office of Zoning Administrator c 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 < — ?ter
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m jJ
<br /> Ordinance, Sanitation Code, an wl h all other applicable County
<br /> Ordinances and the laws and regulations of the State of Wisconsin. 3 d
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<br /> OWNER (please.print) L �� CONTRACTOR or SURVEYOR or AGENT
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<br /> AD KESS ill ADDRESS
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<br /> ADDRESS i � i�<<l
<br /> ADDRESS
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<br /> PP..HL..U.MEB ........................ .. . . .P..H..O..N...E
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<br /> WELL DRILLER
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<br /> ADDRESS ADDRESS n o �-
<br /> P..H...O..N..E.... . .. . ............. . . . . . .. .......................................... O ,:.... ....... ........... ..... ... . .... ....... ..... ....... PHONE
<br /> DESCRIPTION 4. Sanitary Facilities: ° o ° .ik
<br /> 1. Work: 2. New Building Details No. Bathrooms
<br /> New Building .,,...,,,, Type of ConstF 'on: No. Bedrooms
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<br /> Addition ,,,,,,,,,, ,.,,,,�5,,,h,/,S./,Ln ,,.... Septic Tank Size Gals. .......... ;6 '��
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<br /> Sanitary ,. Size .............. ft. x .............. ft.
<br /> .... 4a. Absorption Field Site:
<br /> Filling/Grading .......... Height............. Stories ...............
<br /> Moving .......... Area Soil Type .................................... :� r
<br /> Mobile Home Slope
<br /> Privy ...4...... 3. Use (describe exactly, 1 -family
<br /> Pere. Rate ...................................
<br /> Well .......... home,garage, motel, etc.) Dry Well
<br /> Subdivision Seepage Trench ......... �-t `�
<br /> Camping Unit ''nn .......... .................................................... Privy
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<br /> Seepage Bed
<br /> Location of proposed structures and existing structures, well,sewage systems, roads, etc, should be skotdred in Flg. A. Include road do
<br /> setback, side and back yard dimension and location and setback from all bodies of water- It property is located at a highway Intero-
<br /> section, show the intersecting highways and the setbacks required along thern and at the intersection- CLEANLY LABEL EXISTING ,r t
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<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o'
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<br /> 5. Lot Size: Fig. A. 6. Location:
<br /> ................ ft. x .............. ft. - ............................... sq. ft. ...........................................................................
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<br /> Sign tore of er or Agent Date o"
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<br /> Remarks ....1 .� All!1a-. -La ?Am.t( � nl� � .�'9�>f "���. ���1� r x rr
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<br /> InspectionDate ....................................... ..... .. .. .... .... ................ ,: U v, ol�,o v, m
<br /> Zoning Ad inistrator
<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 I>e made without approval of the Zoning Adm inistratol .
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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