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Burnett County Office of Zoning Administrator a) CD 0 0 <br /> 'A-PPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 <br /> h <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y :W <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinan e anitation Code and with al other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a v <br /> 3 <br /> Q <br /> '1 N <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a `° <br /> ►�'� .. ..1... �..�. .... ..7. ........................................................................... <br /> ..,�. . ...... <br /> ADDR S ADDRESS <br /> :.. <br /> ADDRESS ADDRESS <br /> ...h.. J. .......C).............�..---D.................... .................................................................................... <br /> PHONE PHONE <br /> .......................................... <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS .t h o <br /> < \ <br /> o............................................................... P..H..ONE.. ... .................................................................................. Z r+ <br /> PHONE 3 <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 ° <br /> 1. Work: No. Bathrooms ......... :off T <br /> 2. New Building Details o <br /> New Building Type of Construction: No. Bedrooms Sr•� �' 0 <br /> Se tic Tank Size Gals. 7...... J �« <br /> Addition .......... ............. ......p...... p <br /> Sanitary ,.�--. Size ..... ..............�, ft. x .... ....... ft. • <br /> Filling Height...uQ .... Stories ...... ..... 4a. Absorption Field Site: \ <br /> 7�.Q.....5. ..��� Soil Type ....................................A <br /> r i <br /> MovingArea ........... .. <br /> Slope .......... <br /> Grading .......... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) /� Dry Well .......... <br /> Well ;�. <br /> // /,C/,C Seepage Trench .......... <br /> ...�... � � (.1� /... <br /> Subdivision Privy .......... <br /> .......... .................................................... <br /> Seepage Bed ......... <br /> ---------------------------------------------------------------------- ;J <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road C <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r �<— <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 5. Lot Size: ��� Fig. A. 6. Location: C <br /> ft. x .............. ft. — ..... ..... sq.ft.1................... <br /> CD <br /> 0 <br /> �f / 0 s <br /> o <br /> I o <br /> 21 <br /> C;?C) 0 <br /> CD <br /> ,m <br /> i toed <br /> cnr �� cn <br /> 2. 0 <br /> 2. N 2? Q <br /> r•F 0 _N H '< (Q <br /> Z O p m m <br /> O <br /> 0 70 <br /> G� C4 _ . CD p <br /> .... ... ................... ....g................................... v7... ...�t/ <br /> ............. o C <br /> Si nature of Owner or A ent J Da — <br /> X 70 <br /> Remarks ......................................................................................................................................................................... T i�: T <br /> CD <br /> 0 <br /> ........................................................................................................................................................................................ <br /> :u <br /> ►: _ 0��, <br /> �r,: <br /> C�rnto /. 7A 2�e .................. o 0 o cNsr rm <br /> Inspection Date ....................................... ............. .. . o 0 o 0 <br /> ZoningAdminig'trator u 003000 <br /> Tt <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 />