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trnett County Office of Zoning Administrator C -APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT �-+ 3 ° o <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 c .O <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a v <br /> OWNER (Please print) ............ ......................................................................................... <br /> y.. CONTRACTOR or SURVEYOR or AGENT <br /> 1 M C <br /> .. .., ..../...............3. .,r.... y <br /> .................................................................ADDRESS ........................ � <br /> ADDRESS r. <br /> .. ..e <br /> ADDRESS ✓'..... ............................................................................................ � <br /> ADDRESS ^ <br /> .............................................................. <br /> PHONE QQ,� ] I J PHONE <br /> .. ..l... ...!../..f....y................................ <br /> PLUMBER ......................................................................................... � <br /> WELL DRILLER <br /> ADDRESS ..................................... v <br /> ADDRESS CD <br /> n O <br /> ct < <br /> PHONE ....................................................................................... •° ° o <br /> PHONE : . <br /> DESCRIPTION z y r— a <br /> 4. Sanitary Facilities: ° <br /> 1. Work: 2. New Building Details No. Bathrooms � <br /> New Building ° <br /> Type of Construction: No. Bedrooms ........ . -° <br /> Addition CD <br /> Septic Tank Size Gals. : <br /> ... <br /> Sanitary Size ....1.. ... ft. xQ...... ft. .......... c <br /> Filling Height..T.!.... Stories ..../.......... 4a. Absorption Field Site: <br /> Moving Area ...... Soil Type .................................... :C <br /> 15W............................ <br /> Grading <br /> .......... Slope .......................................... ° <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) , Dry Well h <br /> Well .,S 7J4.f�.S�. .L�.. ... Seepage Trench .......... :� <br /> Subdivision •......... J Privy <br /> ........ i..... .. . . .................... . . . <br /> Seepage Bed <br /> ------------------- : \ <br /> Location of. proposed structures and existing structures,well,sewage systems, roads inter- �etc.,should be sketched in Fig. A. Include road NON <br /> c <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway _a <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. R� y' <br /> -------------------------------------- <br /> i. Lot Size: ------------------ <br /> Fig. A. 6. Location: V� <br /> r� y�? p <br /> yZU.L1.... ft. x .341.0. ft. — .6��....4 t5t?......... sq ft. ., .� ?.. . ......-�.:`.�'..��.. <br /> C <br /> CD <br /> N <br /> O O <br /> v <br /> J rt <br /> N <br /> r -p <br /> CCD <br /> L tQ0-< - � <br /> N <br /> z ooID m <br /> �y s9LO <br /> O' 3 <br /> t3— <br /> � o <br /> :W <br /> m <br /> ure Ow r Agent Date ° C <br /> X <br /> remarks .rs'A.G r .......................................................................................................................... m m <br /> v <br /> ..................................................................................................................................................................................... <br /> ...................................................................................................... .. .................. ....... ... ....................................... . <br /> ispection Date ....................................... �J ; 11 o 0 0 0 o c"I m <br /> 9........... ........ `e 000000m <br /> Zonin Admi istrator 0 0 0 0 0 0 f/) <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 /> is 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 />