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Burnett County Office of Zoning Administrator C - o Z <br /> 0 APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT o <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 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> (y rt o' O <br /> I.�.I.0�A1 ..... t..... .1./1/.. .......................... .......�.�:tv.................................................................. o 0 3 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT CD co <br /> o <br /> ADDRESS ADDRESS a) <br /> ......�-.r...... . a..u..1. .. .... .r.�. -........... CD <br /> ADDRESS \� <br /> ADDRESS <br /> ,237 <br /> ......................... .............. <br /> PHONE PHONE <br /> iw <br /> PLUMBER WELL DRILLER <br /> ........... <br /> ADDRESS ADDRESS CD' <br /> 0 O <br /> ................ <br /> ............ ? I- <br /> PHONE PHONE <br /> DESCRIPTION o 0 <br /> 4. Sanitary Facilities: o ° <br /> 1. Work: No. Bathrooms -0 ` <br /> 2. New Building Details ......••• I <br /> New Building �/ No. Bedrooms o ` <br /> 9 I. Type of Construction: ` <br /> CD <br /> Addition .......... Septic Tank Size Gals. .......... <br /> Sanitary Size ...Awr... ft. x ....c y.. ft. ......•••• <br /> Filling ....••.... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... •` <br /> .......................................... 7- <br /> Grading .......... Slope .......................................... O rt <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) Dry Well .......... <br /> Well . fiq-. ? OCk� Seepage Trench „P <br /> Subdivision Privy <br /> O <br /> ..r.......... 00_ <br /> Seepage Bed C <br /> .......... <br /> ——————————————————————————————————————————————————————————————————— N ,- :�11 <br /> _ocation of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road i 6 .rn <br /> ;etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- N 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. 0Q <br /> ------------------------------ -------------------------------- <br /> O <br /> i. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... - <br /> Cn <br /> yetl0WCD <br /> too 0 <br /> t-- o - O <br /> k oo <br /> ,�tT <br /> ✓`�� C,,, CCD <br /> C, <br /> CD <br /> GaYge- <br /> 01!BIZ yro <br /> fvv)) m c m _. c co <br /> L N 0- Qn. <br /> oy. � : � � � m <br /> o o <br /> z `D fD 70 <br /> o = ; <br /> CD <br /> CD <br /> CD M <br /> ... ............ ..... - D 3 <br /> gnature of Owner or Agent Date <br /> o p <br /> X 70 <br /> �marks ......................................................................................................................................................................... -n M <br /> CD <br /> .................................................................................................................................................................................... O <br /> .................................................................................................... ................ <br /> spection Date ....................................... .... ..... ................. o: o PP 0. v, m <br /> Zoning Adminis /C%.j o 0 0 0 0 o cml� <br /> T E: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> ore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> application before a permit will be issued. Do not purchase or install a septic tank, do any plumhing or start any build- <br /> until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> In 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 />