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Burnett County Office of Zoning Administran,. - o 0 <br /> AuPPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . N_ <br /> 0 <br /> TO THE!ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as h :C <br /> shown hereii!. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseCDc :�1 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a :7 <br /> CL <br /> co <br /> �d.!1............. ............................ .................................................................... 5'...r%5... o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT CD v <br /> .. .. .. ............M..�.�� t�l .�...... .. 4.. ............................................................................................ <br /> ADDRESS ADDRESS !� : <br /> . . C.......................................................... . .. <br /> AD RESS ADDRESSC�....... �. , <br /> ............................................................................. ............................................1.......... .................... <br /> PHO PHONE <br /> ...... .... . .. .. ................................................ _ <br /> PLUMBER WELL DRILLER �� Y0V <br /> .................................... AD.... ..ES..S.............................................................................. ;r� <br /> ADDRESS DR pQ � o <br /> rr < <br /> ............ : 0 r+ <br /> PHONE PHONE ' <br /> DESCRIPTION z `^ 0 <br /> 4. Sanitary Facilities: t ° 0 o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details 0 : : <br /> New Building Type of Cons�trpction: No. Bedrooms ...... '. p <br /> CD <br /> Addition !37 !�i Septic Tank Size Gals. <br /> ......`.' ....... .. <br /> Sanitary .. Size .............. ft. x .............. ft. I. : <br /> Filling „•, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area .............. Soil Type .................................... ,� r <br /> Grading Slope .......................................... <br /> o <br /> Mobile Home Perc. Rate ................................... <br /> ......... 3. Use (describe exactly -famil <br /> Privy home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench .......... PCs <br /> Subdivision .................................................... Privy <br /> ......... y <br /> Seepage Bed ��/`...... r' <br /> ------------------------- Jr <br /> Location of proposed structures and existing structures,well,sewage systems, roads etc., should be sketched in Fig. A. Include road t <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ':�5 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING N, <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 <br /> o' <br /> ---------------------------------------- :. <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — .........b....:;............. sq.ft. ............................................................................... <br /> to <br /> CD <br /> n <br /> �9 <br /> a� . <br /> y' <br /> 0 <br /> s s o <br /> tis t liCD <br /> GI <br /> <) C/)co <br /> CD c m m <br /> 0 <br /> o cn < C . ° 0' �C � <br /> Z o 0 CD : `D 70 <br /> cn <br /> 0 70 <br /> `j.. ....l..y. U o <br /> f(giat re of Owner or Agent Date �* <br /> iemarks ......................................................................................................................................................................... „ mCD <br /> CD <br /> Q\ <br /> ............................................................................................................ ............ <br /> 'ispection Date ....................................... ✓/ �G ..� �— .1+0 0 0 0 o cNii rrn <br /> . ................... . g <br /> g Zonin Admi trator o 0 C 0 Cn <br /> DTE: 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 /> g 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 /> "l SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />