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Burnett County Office of Zoning Administrator C - -- 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT B <br /> rt o <br /> rO 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 e <br /> Jrdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> h <br /> ........................................... ............ ... .. ... ..... ........................................... C ve <br /> N C�1 <br /> OWNER (pl CD <br /> ease p CONTR R or SURV OR r AGENT a y <br /> pZ1.. .. ..r ............................. <br /> 4DDRESS AQgRESS v � <br /> Gvr s5� a/ <br /> ,... .................... ................................ <br /> 4DDRESS A DREL�� <br /> .......................................................................................... \ <br /> 'HONE PHONE <br /> .......................................................................................... . . .. .................................................................................. <br /> 'LUMBER W..ELL.. ..DRILLER <br /> .......................................................................................... .......... <br /> 4DDRESS ADDRESS cD L) <br /> c <br /> o <br /> 'HONE PHONE y M <br /> DESCRIPTION Z H r <br /> 4. Sanitary Facilities: o o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ......•••• o <br /> New Building No. Bedrooms <br /> .......... Type of Construction: : CD <br /> Addition <br /> Septic Tank Size Gals. ' <br /> .......... .................................................... <br /> Sanitary .......... Size .............. ft. x ....... ft....... . . . . <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type .................................... r <br /> .......... Area ........................................... o <br /> GradingSlope .......................................... .+ <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... i <br /> Privy .......... home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench .......... '• <br /> .......... .................................................... <br /> Subdivision I/...• Privy .......... <br /> Seepage Bed .......... <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road I C: <br /> s <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- �1 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. i UW <br /> oW <br /> ---------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x ft. sq.ft. r i <br /> Cn <br /> CD <br /> S1 0 h. <br /> 0 <br /> La <br /> N <br /> '-n W <br /> CD <br /> M <br /> CD <br /> r �� cnooz <br /> 2. cD C CD <br /> 70 CN•y � <c m <br /> z oo `D fD 70 <br /> o <br /> o �p <br /> G�..� ...... p <br /> Signature of Owner or Agent Date ° C <br /> X <br /> Remarks m <br /> .................................................................... CD <br /> .......................................................................................................... ........................................................................... a <br /> N T <br /> Inspection Date , ° ... ............ ................................... u o M <br /> g 0000cnm <br /> on Administrator KJ , to 0 0 0 0 o m <br /> 000000 <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 /> his 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 /> rith 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 />