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Burnett County Office of Zoning Administrator d _ - 0 <br /> 'APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> 0 <br /> TO THt ZONING A'0%TINIS7RATOR: 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 UseCD c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- <br /> A' O <br /> P�191.'7,.r'....... .�.� .................................... .. ............OWNEplease print) CONTRACTOR or URVEYOR or AGENT CD V , co <br /> - y <br /> ` ( � 'a............. ........................................ ic1 <br /> .....Y .. ............................................................................................ d <br /> ADDRESS ADDRESS <br /> 75 ' <br /> .j................................. .............................................................................. i <br /> ADDRESS ADDRESS <br /> l � ' <br /> .............................. .. ................................................ ............................................................................................ <br /> PHO PHONE <br /> IM <br /> ... .. . .......:7��...................................... .................................................................. LV <br /> PLUMBER WELL DRILLER ;C <br /> ............ �O �• <br /> �. <br /> ADDRESS ADDRESS <br /> CD 0 <br /> o' <br /> . . . ..... ... <br /> PHONE PHONE.. . z y <br /> DESCRIPTION 4. Sanitary Facilities: j ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building . Type o�construction: No. Bedrooms . 0 <br /> Addition ,• ..... .......... •,,,•„•„ Septic Tank Size Gals. ....S. <br /> Sanitary ..• Size .... ... ft. x ...3.jo.... ft. <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> MovingArea Soil Type .............................................. ........................................... <br /> Grading .......... Slope .......................................... o <br /> Mobile Home .......... 3. Use (describe exactly 1 famil Perc. Rate ................................... <br /> Privy ,• home,garage, motel, etc.) Dry Well .......... <br /> Well ••• Seepage Trench .......... <br /> .................................................... <br /> Subdivision Privy <br /> ................................................... �..`. :r <br /> Seepage Bed 1.....k$Y <br /> ------------------------------------------------------------------ ~.N (', <br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road c :pl, <br /> setback, side and back property g y � ��77 yard dimension and location and setback from all bodies of water. Ifis located at a highway inter- fl <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. T <br /> 0' <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. <br /> tit •G•` <br /> �C <br /> CD <br /> :,. <br /> � <br /> �-- 0 <br /> Z5 <br /> OC <br /> G <br /> N <br /> S <br /> a <br /> CD <br /> 7 <br /> cn r -0 cn ooLD. z <br /> � fDECD <br /> / c3 NQo_� — ; Q � <br /> � w Gcn m <br /> Z o 0 CD CD <br /> o — <br /> o <br /> CD <br /> .1tu of Owner o Agent Dates ° — <br /> tX <br /> Remarks . ..- . .. ''....:......... �i ..G?,?l c...r! ...� 1: <br /> Gy ram. „ m <br /> -zr CD <br /> ......................... ............. ..... .. <br /> cn M <br /> Inspection Date .. `� .c ..-.. ..... w!lw'.:. ..... ...... . .. o <br /> Z��................ b m <br /> ZoningAdmi istrator o 00 <br /> VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fac tie. <br /> Before 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 /> Nith 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 />