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.7 L/ <br /> Burnett County Office of Zoning Administrator Cn v - 0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y � <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseCDc � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a {- <br /> -� O, f . . Xe..�..,?� ................. OR S <br /> CD <br /> . .O..R... ..A..... .............................. N <br /> Q. <br /> OW ER (please Ynprin � CONTRACT or URVEY or.. GE..NT..... CD '� :� CDADDRESS��. .........../.. ..`......` . . ................. .... ........................................................................... <br /> ADDRESS <br /> so-.... ............. ��...���.............), <br /> ..... s....................................................................................... <br /> 6,2 <br /> AD RE ADDRESS :IQ <br /> ....................................... <br /> :o <br /> PHONE PHONE <br /> PLUMBER W <br /> ...... <br /> ELL..DRI.......LL...ER....................................................................... <br /> D ..................................................... <br /> ADRESS . ..... . ...S................ CD <br /> ............................................................. 0 '� <br /> ADDRES <br /> O <br /> ........................................................ — �C <br /> PHONEPHON.E........................................ ....................................... o ,+ <br /> DESCRIPTION 4. SanitaryFacilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building .......... Type of Construction: No. Bedrooms .......... 6 <br /> Addition .......... .................................................... Septic Tank Size Gals. <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> Filling Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area <br /> Soil Type .................................... �: <br /> o <br /> Grading Slope .......................................... ; <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate .................................. <br /> Privy . . ..... home,garage, motel, etc.) Dry Well .......... I <br /> Well J(.... Seepage Trench .......... r <br /> Subdivision .......... .................................................... Privy <br /> Seepage Bed <br /> ---------------------------- <br /> Location of proposed structures and existing structures well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road <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- <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. `— <br /> ----------------------------------------------- �i 3 <br /> ----------------------- <br /> 0 <br /> r <br /> 5. Lo y�i Fig. A. 6. Location: <br /> .. ,1.�.. ft. x . ft. — .. ..!/ ...L..... sq.ft. ............................................................................... \j <br /> l <br /> to <br /> CD <br /> Lo <br /> sy <br /> 70 <br /> ^� v -n <br /> CD <br /> i C J <br /> zCD <br /> Cn U)Wz <br /> CD CD <br /> m. NQ0-< <br /> d <br /> OC ' G cn m <br /> 7 0 m <br /> ..7 — .� p <br /> .............. ...... ............................... o r <br /> 4j � On Datew <br /> e, m� �j� tea. �rn� r� � - <br /> x <br /> .marks ...�...... ........!.'.......�...v.......... .. ..... ............................................... .. .................. m <br /> ID <br /> CD <br /> v <br /> 1'Y) s ..h .<.....3.........o.�.........s...0� � ......so ... f.. �'... . ...1 � e <br /> ........................................................................................................ . ......................... <br /> spection Date ....................................... ....... i o o cn M <br /> Zonin Administr r �P o 0 0 o V) <br /> ITE: 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 /> h 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 />