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3urnett County Office of Zoning Administrator d - --I0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> f0 THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H 0 <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> CO <br /> Drdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> /� /�,�� I ,,, ,/� ... vj.�C�✓%� '� .... <br /> av O... `" ........................................... <br /> OWNER (please printL GZC i CO RA <br /> R or SURV YOR or AGENT a `� <br /> .................................................................................. , coo L <br /> .... .... .a. .G <br /> ...................................... <br /> a ESS ADDRESS r+ <br /> . ...,2La . ..... ..................................... .,.. .�... r.........:s. ...�1.... �......................... <br /> ADDRESS i2�� ADDRESS <br /> ...... ........................................................................................... <br /> 'HONE PHONE <br /> ............................................................... ....................................................................... <br /> 'LUMBER WELL DRI..LLER.... <br /> .......... 0 <br /> ADDRESS ADDRESS � L� <br /> n o <br /> ....................... o' <br /> 'HONE PHONE <br /> Z ti r <br /> DESCRIPTION 4. SanitaryFacilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ......•••• o <br /> New Building .......... Type of Construction: No. Bedrooms .......... <br /> 0 <br /> Addition <br /> Septic Tank Size Gals. <br /> Sanitary .......... Size ft. x ft. ......•••• ►�: <br /> Filling .......... Height Stories 4a. Absorption Field Site: i <br /> ............. ............... <br /> Moving Soil Type .................................... a• r <br /> .......... Area ........................................... F• ; o <br /> Grading Slope .......................................... y 0 <br /> Mobile Home Perc. Rate " <br /> .......... 3. Use (describe exactly, 1 •family ••••••••••••••••••••••••••••••••••• N <br /> Privy .......... home,garage,motel,etc.) Dry Well .......... tt <br /> Well ,,,,,,,,,, Seepage Trench .......... `• '• <br /> � .................................................... Privy <br /> Subdivision ......•••• <br /> .......... ; <br /> Seepage Bed ......... w :, <br /> _ocation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road O C7 ?� <br /> ;etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- W 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. o O O� <br /> -------------------------------------- . <br /> i. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... 1 <br /> Aj <br /> o C CD <br /> `` C vV <br /> o <br /> o <br /> � a <br /> C <br /> Z <br /> 0 <br /> CD <br /> cc <br /> �o r •n Cl)ooZ <br /> A Xj <br /> 6 <• fD C CD <br /> 'd Ln < <br /> O e� rl1 <br /> Z 00 f9 D � <br /> ° CD <br /> �' 3 <br /> 6`a m <br /> y..'T.-.. �.......... s c <br /> signature of Owner or Agent Date <br /> X <br /> Remarks -n ` '• `• M <br /> CD X3 <br /> CD <br /> ....................................................................................................................................................................................... <br /> ....................................................................................................... ... .... ............... ......... .... ...................................... <br /> Inspection Date m <br /> o; <br /> 000000 <br /> Zoning Adminis rator irJ ° 0000000 <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> Fith 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 />