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Burnett County Office of Zoning Administrator d /M 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o 9� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N ;w <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e �� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a t V <br /> :.... .nG? .................................... 4eel f'��/toles. . . .... ............................ N <br /> a <br /> .. .. ...... ...... . . <br /> C <br /> d . <br /> OWNER (Please print CONTRACTOR or SU RVEVOR or AGENT m - � <br /> ............................................................. ............................................................................................ a :S <br /> ADDRESS - ADDRESS ;� • <br /> m <br /> ........................................................................................... .A.................................................................................. <br /> ......... <br /> ADDRESS DDRESS <br /> ........................................................................................... . . . .................................................................................. <br /> PHONE PHONE.. .... <br /> ........................................................................................... ............DR...ILL......ER....................................................................... <br /> PLUMBER WELL <br /> ........................................................................................... . ......................................................................................... O <br /> ADDRESS A..DDRESS <br /> n o <br /> ........................................................................................... ..... ..................................................................................... o' <br /> PHONE PHO..NE Z H <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathroomso <br /> .......... <br /> New Building ......... Type of Construction: No. Bedrooms .......... <br /> m <br /> Addition .................................................... Septic Tank Size Gals. .......... < <br /> .......... <br /> sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type .................................... r i <br /> o <br /> Mobile Hama .......... Slope .......................................... -• ; <br /> Privy .......... 3. Use (describe exactly1 �family Perc. Rate ................................... <br /> , Dry Well • <br /> Well home,garage, motel,etc.) ......' <br /> subdivisionSeepage Trench .......... <br /> Camping Unit .......... .................................................... Privy <br /> .................................................... Seepage Bed i <br /> ---- ------------------------ -------------- .N i <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road e ;� <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 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. H <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> L 0. <br /> N O <br /> —i 1 o <br /> N <br /> i <br /> r �oFmmz <br /> 0 <br /> m s. m <br /> Z D n <br /> o j n <br /> EWA � <br /> �5 IN m <br /> ......................... ..........1?.. ...................... 0 C <br /> Signature of Owner or Agent Date X . <br /> Remarks ......................................................................................................................................................................... m : m <br /> :X3 o <br /> ........................................................................................................................................................................................ <br /> t <br /> 7 �Cx... ......... ................... �t�t Nva . Nm <br /> Inspection Date ....................................... ..Q�?Z. ..........:.....................G�.�..a..� !.................. u, u, o o v, m <br /> Zoning Adminierator ,<--) 8 8 8 8 8 8 y <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 he 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 /> - <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 />