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ett County. Office of Zoning Administrator W CD 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o ?p <br /> TO TFIE 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 Use CD <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> ........... o <br /> 1�........ .......................... ........ � /..........5 ' -r: ✓?................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a h <br /> / <br /> / ............. �...�..... �.�........... ............................................................................................ ° <br /> ADDRESS ADDRESS m "'r V1 <br /> ADDRESS ADDRESS <br /> .. ........................................................................................ .................................................................................... r %S <br /> PHONE .- PHONE <br /> .���e. !�� ........ T..................... .......................................................................................... �. <br /> PLUMBER ` WELL DRILLER <br /> ...... f3l�..�.. �.. /......5zf d'3. .. o `p <br /> ................................................................................. iYa <br /> ADDRESS ADDRESS co <br /> ct <br /> PHONE PHONE <br /> < <br /> 0 <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 <br /> 1. Work: No. Bathrooms T <br /> 2. New Building Details o <br /> New Building .. Type of Construction: No. Bedrooms .......... <br /> Addition ?� f7n Septic Tank Size Gals. <br /> ..................... . < <br /> Sanitary x... Size .............. ft. x .............. ft. .......... <br /> Filling .....•.... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... r <br /> .......................................... <br /> Grading .......... Slope .......................................... ° Z <br /> Mobile Home 3. Use (describe exactly, 1 family <br /> Perc. Rate ................................... <br /> Privy home,garage, motel, etc.) Dry Well .......... <br /> ... <br /> Well Seepage Trench ?� <br /> Subdivision „•,•• Privy .......... <br /> Seepage Bed .......... <br /> —————————————————————————————————————————————————————————————————————— 1 C— <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road <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. N <br /> — ---------------------------- ---------- ---------------- <br /> 5. Lot Size:, Fig. A. 6. Location: =- <br /> .3.30... ft. x . 1 VU ft. — ............................... sq.ft. ................. �'..�i�/lt ...I�0.4 ................. <br /> n <br /> CDrt <br /> N 0 .q 0. <br /> E� 7 <br /> r+ <br /> 0 <br /> :el� —� <br /> m <br /> CD <br /> tn tncoz\ <br /> c m mC ID <br /> n 0, 7 < N = <br /> m. Naa< — a <br /> OH:C ' Gco m <br /> z o o `D CD 70 <br /> � <br /> CDo �. <br /> o <br /> M <br /> Sign ture of Owner o ent Date <br /> U....S.nG:..T......`.:^�:�....................................................................................................................... T 0 <br /> Remarks ...:.. .. <br /> m <br /> ...................................................................................................................... �r <br /> J f. <br /> Inspection Date . ./....� �.f..:...... ,,, „ .2'` o 0 0 0 0 L T <br /> .................... <br /> Zoning AdministaHtor Q: 0 0 0 0 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fyci ities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with 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 />