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Burnett County Office of Zoning Administrator C -1 -- 0 <br /> APPLICATION FOR SANITARY — LAND USE -- BUILDING PERMIT v _ <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H 0 :W <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD C. <br /> (Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a W <br /> . . . ........ ....0 . J ................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> 01 <br /> ADDRESS ADDRESS <br /> . .......... •r........................... ...... ,��o,� 4X <br /> ADDRESS . ............ .............................................. <br /> ADDRESS f <br /> PHONE PHONE <br /> ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> .......... p <br /> ............... _. <br /> ADDRESS ADDRESS G) <br /> h o <br /> .............................................................................. ............................................................................... O '. <br /> PHONE PHONE y <br /> DESCRIPTION Z H r <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> New Building Type pf Construction: No. Bedrooms M <br /> Addition .......... Rp Septic Tank Size Gals. <br /> ft. x ...... p <br /> Sanitary Size .. ft. ••••••••••.......... ........... .. . . . . <br /> Filling .......... Height Stories 4a. Absorption Field Site: <br /> Moving .......... Area ......................................... <br /> Soil Type .................................... <br /> GradingSlope .......................................... �+ <br /> Mobile Home •••••..... 3. Use (describe exactly, 1 -family Perc. Rate ................................... i <br /> Privy ••...•.••. home,garage,motel, etc.) Dry Well <br /> .......... <br /> Well Seepage Trench ' <br /> .......... aRA e............ <br /> Subdivision „•,,.•,,, ✓ y <br /> ...... ............................................. <br /> Privy .......... <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- <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 C <br /> yard dimension and location and setback from all bodies of water. If property is located at a highway inter- p n. <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 /> o r r . Cn <br /> f w <br /> N O <br /> O 7 <br /> r � <br /> N w <br /> y CD <br /> Z <br /> = CND O <br /> I ' J <br /> oD <br /> `•\ X cnr - cnco Z <br /> 4CD c m 2 M m C CD <br /> \\7 <br /> •< to M <br /> Z o o' fD 70 <br /> ° � 3 <br /> o :F m <br /> " 1 ? --- ---- / <br /> /marks <br /> ...... . ..or......................................... ................. ............ o e <br /> f Owner Agent DateUw� ti �:.F* ..1.z�44................... .... . .......................................................................................... CD <br /> v <br /> 6 <br /> ........................................................................................................................................................................................ J u <br /> 1c JInspection Date !'? ............ ............ o 0 0 0 (T7 <br /> Zonin Adminis rator �� E 0 0 0 0 0 <br /> 000000 <br /> QOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> iefore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> vith 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 />