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Burnett County Office of Zoning Administrator 3 - o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 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 <br /> Ordinance, Sanitation Code, and with all oth applicable County Ordinances and the laws and regulations pf the State of Wisconsin. a <br /> .......�).-F'.�J. �c1. a . .. ........................ 1 ...... ... . ................................ <br /> N <br /> '7 ^ o <br /> OWNER ri tl ONTR O or SURVEYOR or AGENT <br /> a <br /> u :S <br /> ........ .. .................... ........................ ..... .................... ............................n...................... O_ t <br /> ..... ... .. <br /> ADDRESS � ADD E ���� <br /> . .. . .......... <br /> ................. ..... <br /> ADDRESS // DRESS <br /> �L�.. ... �...................... .............................................. ............................................. <br /> PHONE PHONE <br /> ........................................................... . .E.L...L.D....RI........LLER..................................................................... "O <br /> PLUMBER W � <br /> .......... <br /> .A.......................................................... <br /> ...................... <br /> ADDRESS DDRESS � o <br /> 0 < <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details <br /> New Building Type T No. Bedrooms U <br /> .. of Construction: CD <br /> Addition „•,,.•„ .....6w.. /•,.... Septic Tank Size Gals.SanitarY Siz ....— t. x ... .Q4+ft. -� <br /> Filling ,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... r— <br /> Grading Slope .......................................... r. <br /> o <br /> Mobile Home 3. Use (describe exactly, 1 family Perc. Rate ................................... <br /> Privy home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench .......... '• <br /> Subdivision Privy .......... <br /> .......... <br /> ---- --------- -------------- --- Seepage Bed------------ <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> ` 6 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter °- <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. y <br /> n o <br /> --------------- -- --------- <br /> 5. Lot Size: / Fig. A. 6. Location /' i` <br /> ��1..�... ft. x04•l�.. ft. — ............................... sq.ft. ... .�Q J : <br /> •� -- 0/ rn <br /> ID <br /> l� �! N o' <br /> O 7 <br /> r I ''V <br /> 0 <br /> 0 <br /> CD <br /> ID <br /> C0) <br /> m NQO_ < — + Q <br /> 'O Cal <_• O M <br /> ti < � ITt <br /> D CD <br /> 00 <br /> U1 9 —� <br /> ,:. 40.. .... . ....V.. ...... o <br /> signature of 0 er or Agent e <br /> X <br /> : : <br /> Remarks ..... ........................................................................................................................... .................. ........ .......... -n Mm <br /> m <br /> ........................................................................................................ . .......................... ................................................. <br /> N <br /> inspection Date .� � 6 6 o cn m <br /> ....................................... <br /> Zoning Admi istrato�� : R: o 0 0 0 0 o N <br /> OTE: 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 /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith 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 />