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Burnett County Office of Zoning Administrator v - -� Z <br /> o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 <br /> TO 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 <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> O <br /> ................ ....................................................... .......................................................................................... W CC <br /> OWNER (please.......p... ..... <br /> nt) CONTRACTOR or SURVEYOR or AGENT cue <br /> �o�ce , .. ............................ <br /> . . . .. ti �� ............................................................................................ <br /> ADD SS ADDRESS <br /> v <br /> • e..�. ?.N......................................... <br /> ADDRESS ADDRESS <br /> PHONE . . . . ................................................................... KN <br /> ............... <br /> YV <br /> PHONE.. � <br /> .......... <br /> PLUMBER WELL DRILLER <br /> ' pADDRESS . ............ . . . ................................................................................ co .� <br /> ADDRESS <br /> n o <br /> PHON <br /> PHON.E................................................................................. a' <br /> E <br /> DESCRIPTION o Ll <br /> 4. Sanitary Facilities: o ° � <br /> 1. Work: No. Bathrooms � <br /> 2. New Building Details •••••••••• ,- ; <br /> New BuildingNo. Bedrooms ° <br /> Type of Construction: el <br /> Addition .......... Septic Tank Size Gals. <br /> . ......................... <br /> Sanitary ...... Size .............. ft. x .............. ft. <br /> Filling .....••••. Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ................I.......................... Soil Type .................................... ^� <br /> Grading .......... Slope .......................................... <br /> Mobile Home Perc. Rate ........................ ....... 3. Use (describe exactly, 1 -family ••••••••••••• <br /> Privy ........•. home,garage, motel, etc.) Dry Well .•........ w Y ! <br /> Well Seepage Trench <br /> ......—-...................... <br /> Subdivision Privy .........• it <br /> ,.� <br /> .................................................... . . <br /> Camping Uriit Seepage Bed ......,,,, r`, <br /> ---- - --------- ---------------------------------------- ��N <br /> _ocation of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road C <br /> ;etback, side and back �1: o-�•� T yard dimension and location and setback from all bodies of water. If property is located at a highway inter- �R6?(n a� -- <br /> ,ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING0 5 <br /> 'TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> \----------------- °------ <br /> ----------------------- <br /> i. Lot Size: <br /> Fig. A. 6. Location: i <br /> /0.O....... ft. x 13 Via... ft. — ............................... sq.ft. <br /> ............................................................................ . <br /> Application for land use <br /> (6 month period) t. <br /> Camp�*ng Permit from to � �0 <br /> ✓, %' (date) (date) o <br /> 0 <br /> CD :\ <br /> CD <br /> C/) Cn M Z <br /> T. NQa.� - ,-+' a <br /> m <br /> Z O °• CID I <br /> .p can <br /> � �� m <br /> ignature of O r or Agent Date ° C <br /> remarks ... ... ry <br /> x <br /> .......—�-,•+lam ...Q.:.�`.�. (�' .G'�-c-.�'.... ................ m <br /> " -�-d v <br /> -"-�!'....... .....mil-. ................. � — CNn <br /> :.. ...... <br /> ....... <br /> ........... .......... ... ...................3 .... .......................................... 1 : g . . . . <br /> ispection Date .............. o m <br /> 0 <br /> Zoning Ad istrator o 0 0 o cmi) <br /> DTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> is application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> 3 until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> th is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />