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Iurnett County Office of Zoning Administrator ( - -- 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y <br /> sown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use - c <br /> rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> r' a <br /> c,(�iM. .. ... t�.P.P..A....................................... — o <br /> WNER (please print) CONTRACTOR or SURVEYOR or AGENT a — <br /> i <br /> a <br /> DDRESS ADDRESS <br /> 1 ' <br /> DDRESS ADDRESS <br /> ............................................................................. ............................................................................... �G! <br /> BONE �� � � PHONE <br /> ............................................................................ ......................................................................................... <br /> _UMBER WELL DRILLER <br /> O - <br /> ............... ........... : : <br /> DDRESS AD..DRESS o <br /> h o <br /> ........... ?' :-: <br /> BONE PHONE <br /> z r <br /> 4. Sanitary Facilities: ° ° <br /> DESCRIPTION o <br /> Work: 2. New Building <br /> No. Bathrooms <br /> x Details <br /> New Building r \ Typ of ons ruc ion: No. Bedrooms <br /> o <br /> Addition „••••• ,> d!o ,S Septic Tank Size Gals. <br /> Sanitary ..•,,,•,•. Size ..... ft.x .,2.�.... ft. •••••••••• <br /> Filling .......... Height............. Stories .../........... 4a. Absorption Field Site: <br /> Moving Area ........................................... Soil Type ....................... / o <br /> Grading .......... Slope .......................................... <br /> Mobile Home ......,... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .....••... home,garage, motel, etc.) <br /> Dry Well <br /> Well A � Seepage Trench .......... <br /> P :..cam... ..........Subdivision Privy .......... k ' <br /> .................................................... <br /> Seepage Bed ......... <br /> ------------------------------------- <br /> Dcation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road 4 <br /> tback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- �N Cr <br /> ction, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < <br /> fRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. L. <br /> \o <br /> --------------------------------------------------------------------- i <br /> L Siz� Fig. A. 6. Location: <br /> x ............. ft.J oZD...O................. Iosq.ft. .. ...................................................o <br /> New —�� �. Cn <br /> CD <br /> N O' <br /> o <br /> cn :tiJ <br /> l / C0 <br /> G <br /> ' Q <br /> n d <br /> T" G 1n <br /> M Cnr- T� Cncoz <br /> ,. CDC CD <br /> m �QQ� — �—r' p <br /> N—• c� <br /> C < in m <br /> a Lkzj <br /> cn <br /> RA 6 <br /> :C4 CO <br /> gn ure of Owner or A t (/ Date <br /> X 0 <br /> amarks -n ? m <br /> m <br /> � ' <br /> ..................................................................................................................................................................................... — <br /> u <br /> ..................................................................................................... .......................... . <br /> spection Date <br /> ' .............--.............. 000000 <br /> Zoning A 0 0 CD CD <br /> nistrator 0 0 0 0 0 <br /> )TE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> Fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> s application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> I until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> th 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 />