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Burnett County Office of Zoning Administrator C o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. Z <br /> TO TxiE'ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as - N <br /> \n <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. 0_ <br /> II h 0 »,y P <br /> i{...Y.7'�. .T•......1.... .� 1V1............................... W.•••••...T..S..i.i l..l.�......•........•.........••...••..•. N (D <br /> OWNER (please print) CONTTOR or SURVEYOR or AGENT a D <br /> Th....C,.�a.�c./;z. t"�/.... f� r ll.e,/./..... .... �.1 <br /> ADDRESS ADDRESS <br /> �P .Y... ...-... X... ... ........................ <br /> ............... <br /> ADDRESS ADDRESS w t T /ram <br /> 2.......................... <br /> PHONE PHONE <br /> ................ ; <br /> PLUMBER WELL DRILLER 1A/ <br /> p ^� <br /> ADDRESS ADDRESS io G) <br /> 0 0 <br /> ........................................................................................... ............................................................................................ :0 0 <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: 0 0 <br /> No. Bathrooms <br /> 1. Work: 2. New Building Details o <br /> New Building Type of Construction: No. Bedrooms .......... -CD <br /> 0 <br /> Addition Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... o <br /> .......................................... Slope ................ <br /> Grading .......................... <br /> .......... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel,etc.) Dry Well :......... <br /> Well Seepage Trench .......... <br /> ...................................... Privy <br /> Subdivision <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- N <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road ;m <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- CL <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. 0 <br /> ---------------------------------- ----------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ......... sq.ft. ............................................................................... <br /> _ cn <br /> c <br /> CD <br /> N O <br /> 0 <br /> Lo <br /> 1 N <br /> ' � S <br /> -i tt <br /> T :l^� <br /> ^> <br /> z <br /> 0 <br /> v <br /> o <br /> �o an r— -a cn co z <br /> c dC CD <br /> 0 Nan ce co Q � <br /> Oh CD < cQ m <br /> z o 0'fD m 70 <br /> p 6 0 <br /> VIP o �' <br /> p/�� <br /> 0� m <br /> ............ <br /> V' :Z)oh C <br /> Signature of Owner or Agent Date V V\ <br /> • X � <br /> Remarks -n CD <br /> CD <br /> ........................................................................................................................................................................................ <br /> ........................................................................................................... ...................... ........ .... ..................................... L It . <br /> Inspection Date ....................................... ( ... / ............. .............. ?(�: o 0 0 0 o cNii m <br /> : 0 000000m <br /> Zoning Admini rator K� d: 4 0 0 0 0 0 0 � <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 />