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:sett Co4tity Office of Zoning Administrator a) CD 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT v 3 \ <br /> o ;W <br /> I HE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < y -^ <br /> ,wn herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use cD <br /> v <br /> rdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> Z CD <br /> .. .......... �.�...................................... <br /> k- <br /> 0 <br /> DW ER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .....P�,.d..... u .S ....................................... <br /> 4DDRESS ADDRESSCD <br /> 1 . f.s........ . .. .........`.. ..................... .......................................................................:... <br /> 4D1DRES ADDRESS <br /> .................................. ...................................................... ............................................................................................ <br /> H NE f <br /> le l S U,eF er PHONE o� <br /> .0 ........... ................ ........................................... *� ;�:' . . .. <br /> :'LUMBER WELL DRILLER <br /> . . ........................................................... ................... <br /> ADDRE , 6l O ADDRESSCD <br /> �j0 o <br /> PHONE PHONE Z y r <br /> DESCRIPTION 4. Sanitary Facilities: o o <br /> 1. Work: 2. New Building Details No. Bathrooms -^�. p o <br /> New Building .......... Type of Construction: No. Bedrooms /..-�,��.} .Q :9J <br /> Septic Tank Size Gals. (. r/.�! �, <br /> Addition �1 <br /> ......... ................................................. .. t- w <br /> Sanitary K.... Size .............. ft. x .............. ft. V <br /> Filling •......... Height............. Stories ............... <br /> 4a. Absorption Field Site: y <br /> Moving Soil Type .................................... <br /> ......... N: : <br /> Area <br /> Grading .......... Slope . ........ .. .... .. .................... ° <br /> Mobile Home ::..:..... 3 homUse e(describe aotly, -family Dry Rate ...` Z.—.• ........••• o` <br /> Dry Well <br /> Privy garage, otel,� �1y <br /> Well Seepage Trench .......... )• <br /> .................................................... <br /> Subdivision Privy ...... ... : <br /> ......... .................................................... <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 s <br /> setback, side and back yard dimension and location and setback froM all bodies of water. If property is located at a highway inter- fl <br /> section, show the intersecting highways and the setbacks requiWO along them and at the intersection. CLEARLY LABEL EXISTING �' y• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ----------------------------------------------- --- ---------- ib <br /> 5. Lot Size: Fig. A. 6. Location: s <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................. r 3 <br /> oh <br /> Z_ aCD <br /> o ^ <br /> c �• <br /> Lo <br /> s 0 <br /> o <br /> 70 <br /> �F + <br /> CD <br /> z <br /> r: o <br /> CD <br /> C/) 00 z <br /> CD c d �. m co <br /> -o cn < C : m <br /> oN. N T <br /> z 00 fD `D N <br /> .v v, <br /> Ro <br /> ... .. .................................... ........................... .......................�.......... w o p <br /> Signature of Owner or Agent Date — <br /> X <br /> Remarks ........................................................................:. ,, m <br /> CD <br /> o O: 0 <br /> CD <br /> .......................................................................................................... ............................................................................. o N T <br /> Inspection Date ....................................... ..�..... ..... .....?41.......................: c. o 6 0 o o m <br /> Zoning Ad nistrator ' N <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 />