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Burnett County Office of Zoning Administrator CU CD o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> 0 \ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H -^ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD e <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a U� <br /> y �/� '+ m O <br /> (/ i�Y�/p/���� ! • - �//7✓w"�V i ........... N `D <br /> (/y{(,(,,...t.f..:................................................... ............... ...NYf..:..'.....:.... ................LI.Y... ...... C <br /> OWNER (please print) CONTRACTOR or SUR YOR or AGENT a <br /> ADDRESS ADQ./RESSCD <br /> /L......Cv`'l / . 7.. <br /> ........ <br /> ADDRESS ADDRESS s�C <br /> ........................................................................................... <br /> PHONE PHONE <br /> ......................................... <br /> PLUMBER WELL DRILLER <br /> .......... <br /> ............................................... <br /> ADDRESS ADDRESS.................................................................. m G� <br /> o <br /> PHONE PHONE z o � <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building No. Bedrooms <br /> .......... Type of Construction: CD Addition Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type .................................... r <br /> .......... Area ........................................... o <br /> GradingSlope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench .......... '• <br /> ............................................I....... <br /> Subdivision ,,,/ Privy .......... <br /> ................................................... Seepage Bed <br /> ------------------------------------------------------------------ N <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x .............. ft. — ............................... sq.ft. ........................................................................... CD <br /> .... <br /> N. <br /> r-F <br /> C0 <br /> G <br /> t> N <br /> 7. <br /> o <br /> m <br /> Lo <br /> CD <br /> rv� cnooz <br /> CCD� 00 � < D � c m <br /> T. <br /> cn < <br /> z 00• (D N <br /> 0 3. <br /> cn f9 -1 <br /> o <br /> v 0 <br /> CD M <br /> Signature of Owner or Agent Date — <br /> X 70 <br /> Remarks ......................................................................................................................................................................... <br /> CD <br /> m <br /> t <br /> ........................................................................................................................................................................................ — <br /> IN u <br /> ,....................... Gl <br /> h r n E, Lon 0 0Ns� T <br /> r.� ... . J:"\ o 0 o m <br /> Inspection Date ....................................... ............... ... .J......... 0 0 0 0 0 0 o m <br /> Zoning Administr� 0 0 0 0 0 0 to <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 />