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i -r77F <br /> 3urnett County, <br /> Office of Zoning Administrator v CD o o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> -O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as o <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c ;q <br /> )rdinance,, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 cD <br /> ket.ti1 / o <br /> .................... ................................... f�.ti..r.:.....c.r.....d................... <br /> )WNE�(pleas print) CONTRACTOR or SURVEYOR or AGENTCD <br /> 1..L. ..1............. ...............� .1`.... .................... <br /> ADDRESS ADDRESS <br /> v •� <br /> •Lt ...... . ............................................................................... ( :� <br /> ADDRESS ADDRESS <br /> 'HONE PHONE <br /> E- u.P. .n..S............................................. ............................................................................................ <br /> 'LUMBER WELL DRILLER <br /> ......................................................................... ........................................................................... <br /> ADDRESS ADDRESS m C <br /> M O ' <br /> 'HONE PHONE z N <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> I. Work: 2. New Building Details No. Bathrooms r,-\ <br /> New Building .... Type of Construction: No. Bedrooms ••• � <br /> Addition /� cp OWN Septic Tank Size Gals. <br /> ... ................................. .. <br /> Size .. ..zi/..... ft. x ...�'�. ft. 7:^.... >:� <br /> Sanitary •„ k.... <br /> Filling •.. Height............. Stories ............... 4a. Absorption Field Site: (1� <br /> Moving Area Soil Type .................................... r <br /> .......................................... <br /> Slope .......................................... ° <br /> Grading Sl <br /> ......... <br /> Mobile Home 3. Use (describe exact) 1 -famil <br /> Perc. Rate ................................... <br /> Privy .., home,garage, motel, etc.) Dry Well .......... r-N <br /> Well Seepage Trench .......... <br /> ... <br /> Subdivision •••••••••• Privy <br /> Seepage Bed /.8...... :G <br /> ---------------------------------------------------------------------- <br /> Cn <br /> -ocation of proposed structures and existing structures, well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road :M c <br /> etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a <br /> ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> >TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. R. <br /> o' <br /> -------------- ---------- ------------------------------------ <br /> i. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. - ............................... sq.ft. ............................................................................... Q <br /> U) <br /> CD <br /> 0 <br /> N o <br /> o <br /> M <br /> cn ;� <br /> N <br /> rh <br /> 0 <br /> C0 <br /> G <br /> ^ti <br /> T <br /> m �C� <br /> z �- <br /> O <br /> v <br /> CD <br /> Co <br /> 01 co <br /> 0 CD3 �. c <br /> oCD <br /> cn <• C : ° - <br /> o (N t <br /> Z o o' `D <br /> o <br /> o 7� <br /> p <br /> :............. ....... .................................... <br /> Signature of O/w�n//ee�rpDor Agent - Date <br /> Remarks ......41.`�1.....e��.�!r b....e.�7 ..../..°.....10 ....{� snaL I .'................................................ - x M <br /> CD <br /> ................. ............................. .. <br /> 00o Lnm <br /> Inspection Date /y..... g o 0 6 0 0 0 <br /> Zonin Ad ininr 000000c/) <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> ,iis 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 /> rith is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Administrator. <br /> �VSEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />