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Burnett County Office of Zoning Administrator / C ° o Z <br /> o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as v, <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> s...�....-.../�..../�..�t` L.S,Dn/ ............................................. ... .... ...... .. y a <br /> 'allo <br /> :� <br /> OWNER (please print CONTRACTOR or SURVEYOR or AGENT a CD <br /> �. <br /> r ...f......�'Q .. ...................................... ............................................................................................ C <br /> ADDRESS ADDRESS <br /> ........... ......................................................................................... <br /> ADDRESS! s <br /> ADDRESS <br /> ........... 1 . ....... s..s'��.......................................... : '. <br /> PHONE PHONE t ' <br /> W.E.......DRI.... ............................................................................. <br /> PLUMBER LL LLER y1 <br /> v_........................................................................................... . ....... ............................................................................ : <br /> ADDRESS A..DDRESS...... <br /> o <br /> PHONE ....................................... ONE.........................................:............................................. �: <br /> PH Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> o <br /> New Building .... Type of Co truction: No. Bedrooms .......... -o <br /> Addition ................. 0-ox's 6 Septic Tank Size Gals. .......... <br /> Sanitary Size .. ......•••• <br /> Filling .......... Height............. Stories ..../......... 4a. Absorption Field Site: <br /> Moving .......... Area .................................... Soil Type .................................... r..... <br /> GradingSlope ....................................... .. �« ; <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home, arage, motel, etc.) Dry Well <br /> Well ?�p � Seepage Trench .......... <br /> .......... <br /> Subdivision Privy .......... <br /> .................................................... <br /> -------------------------------------------------- Seepage Bed----------------- <br /> ed ------ N--- ): <br /> --- , <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road a <br /> a- <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 /> 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 /> ------------------------------------------------------------ �J <br /> 5. Lot Size: Fig. A. 6. Location: f <br /> r ; :� <br /> ................ ft. x ft. ........... sq. ft. CD <br /> C <br /> NOOp <br /> O � <br /> o <br /> CK0 C� ' <br /> —�-.--- , <br /> to <br /> ID <br /> cnCD Cl) <br /> L-,A oo z <br /> o cn < C: <br /> <n H cn M <br /> Z oo'`D fD <br /> 0 <br /> �... .......... 1'' ..... �� <br /> g o C <br /> nature can ent er or A Da <br /> �a,� <br /> Remarks ........... %' ........... � !";...... ..................................................................................................... � ` v <br /> u <br /> .......................................................................................................`... <br /> mInspection Date <br /> . ............................... <br /> p75, ../......... .. �;��Winis�ra <br /> :l C: o 0 0 0 0Zoning K J :� o 0 0 0 �o tm/� <br /> DOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> iefore 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 /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> vith 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 />