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Burnett County Office of Zoning Administrator a) CD 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. % <br /> o :Q <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as � N -h <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD m V <br /> Ordinance, Sani ation C de,and with all other applicab County Ordinances and the laws and regulations of the State of Wisconsin. 0- <br /> (� <br /> N a <br /> ffo.(please pr TOR or SURVEYOR or AGENT. ... v.. rrt�. ....... '-........... <br /> fV ES ADDRESS -« <br /> ........................................................................................... <br /> ADDRF„SSS ADDRESS <br /> ................... ...................................................................... ............................................................................................ <br /> PHONE PHONE . <br /> ........... ............................................................................................ (� <br /> PLUMBER WELL DRILLER <br /> ......................................... AD......D.RES....S.. .. CD............................................................................ <br /> ADDRESS L) <br /> 0 o <br /> .................................................................................. ............................................................................................ o <br /> PHONE PHONE z N � <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••••••••• � o ' <br /> New BuildingT No. Bedrooms 0 <br /> ype of Construction: <br /> Addition .... y........ Septic Tank Size Gals. .......... �+ <br /> Sanitary .........• Size ...ft. x 0r�./Gd.. ft. <br /> Filling Height..... Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ... t .�^FFr .G�... <br /> Soil Type � <br /> 0 2 <br /> Grading .......... Slope .......................................... ; �« <br /> Mobile Home •......•.. 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy „••...... home,garage,motel,etc.) Dry Well .......... <br /> Well Seepage Trench .......... <br /> ......... .................................................... <br /> Subdivision Privy ......•••• <br /> .................................................... � ^ <br /> ------- Seepage Bed .......... I ~J <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road C <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- o <br /> C' <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING W N• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. C1� P� p' <br /> -------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ........................ <br /> m <br /> N F, O <br /> � o � <br /> ! Field , <br /> CD <br /> ° <br /> I � <br /> CD <br /> d <br /> House � <br /> -�`` 1 <br /> s� i 1 •� <br /> Cn� n.0) Z <br /> cn <br /> CD <br /> -�l // 0 a3m ' <br /> EQ <br /> �� p <br /> ..�.... �— <br /> o <br /> Signature of O er r A en ate �+ <br /> 7 / q X <br /> Remarks .�.:�f�.. • .. ...SP. ..�/ -n <br /> CD <br /> CD <br /> ........................................ .. ............................... .................................... <br /> ................................................................. <br /> : tom. E, EDC Nnm <br /> Inspection Date ��. ..................... o 0 6 0 6 0 <br /> Zoning Adminis rator o 0 0 00 o cn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <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 />