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Burnett County Office of Zoning AdministratorW CD o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . ;\ <br /> r0 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 CD O \1 <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> HCD <br /> a <br /> — m <br /> ...... ..... .... ........................ � :✓ �:`�'"'•.. ........ ... � <br /> U2w, <br /> ER (please print) ���� CO TRACTOR r SURVEYO;�cr m <br /> y ,.L�/........, ...4V'y.....�.................................... 4`C - ... -4�� ��. <br /> ADDRESS ADDRESS V S. <br /> ................................................... ...................................... v <br /> ADDRESS ADDRESS <br /> ............................................... <br /> PHONE PHONE :\ <br /> ..............'........................................................ ......................................................................................... <br /> PLUMBER WELL DRILLER '. <br /> 0 <br /> ADDRESS ADDRESS C o <br /> + < <br /> .................. .................................................. o rr <br /> PHONE PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> :e <br /> 1. Work: 2. New Buildin Details No. Bathrooms o <br /> 9 <br /> New Building .......... Type of Construction: No. Bedrooms .......... CD <br /> a :R <br /> Addition •••••„•„ ...... „...... ••... Septic Tank Size Gals. jR + <br /> Sanitary Size .............. ft. x .............. ft. ....... <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> SoilType .................................... r <br /> Moving Area ........................................... o <br /> GradingSlope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .....I.... home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench .......... <br /> Subdivision �/ Privy .......... <br /> ......... .................................................... <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- cn <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road s <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 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.---------------------------------------------------------------------- <br /> o 0 <br /> 3 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. .............................................................................. Cn <br /> dj"ze1"el CD <br /> F <br /> I N O, <br /> QQ q � � 7 <br /> / <br /> y• <br /> r+ <br /> OC <br /> G <br /> N <br /> \ \ ; 7• <br /> N <br /> Z <br /> O <br /> CD <br /> _ T Cn07Z <br /> C 6 dC CD <br /> -O U1 < 0 -0 <br /> b M: •< g m <br /> z oo <br /> O 3 <br /> m <br /> Signature of Owner or Agent Date <br /> X 70 <br /> Remarks ......................................................................................................................................................................... -n mm <br /> Co <br /> rfl <br /> ..................................................................................................................................... .................................................. Xi <br /> Q�r�'J / ��' _ _L�� 0 0 0 0 o cn m <br /> Inspection Date ....................................... g........ .... . : j t b b b o b b m <br /> Zonin Ad inistrator Y : 0000000 <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 />