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Burnett County Office of zoning Administrator `n - - 0 <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 < H 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n. <br /> '+ 0 <br /> t~..... .... �n%% ... .�L............ ............................... ........ .... ... ........... ............................. _. <br /> r+ <br /> m <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a m <br /> S..T..B. - �. . - ... �.........e. x... a..�........ Q <br /> ADDRESS t ADDRESS <br /> .......... ill. ......................... ............................................................................................ <br /> ADDRESS ADDRESS <br /> ............ ..� .........3..9.. ...4..................................... ............................................................................................ <br /> PHONE PHONE <br /> ........... ;L11 <br /> ................. ... .. .... .......... <br /> PLUMBER WE..LL...DRI.LLER <br /> ................. ........................................................................ <br /> ADDRESS ADDRESS.. CD <br /> 0 <br /> ..................................................................................... <br /> PHONE PHONE...... z y <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> No. Bathrooms _01. Work: 2. New Building Details o <br /> New Building Ty of Construction: No. Bedrooms <br /> ......... : . <br /> Addition - Septic Tank Size Gals. <br /> ... ..... <br /> Sanitary .......... Size ....9. ft. x ..lo.p..... ft. ......•••• <br /> �r 4a. Absorption Field Site: <br /> Filling ,,,,,,..., Height............. Stories ./............. S�, <br /> Moving .......... Area Soil Type .................................... r <br /> ........................................... l ° <br /> Grading Slope .......................................... <br /> Mobile Home Perc. Rate ................................... <br /> ,•........ 3. Use (describe exactly, 1 -family Je, <br /> Privy home,garage, motel, etc.) Dry Well .......... d <br /> Well Seepage Trench <br /> t1R,4.-�rt..r4 -`..... .. .. . <br /> Subdivision Privy .......... ( : <br /> ........ .................................................... <br /> Seepage Bed .......... 3 <br /> ————————————— <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- ^ a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING y <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> ---------------------------------------------------------------------- 3 <br /> 5. Lot Size: Fig. A. 6. Location: rJ <br /> ................ ft. x ft. sq.ft. (n : <br /> cn <br /> CD <br /> 0 <br /> j. <br /> 0 <br /> -n `C <br /> C...: CD 0 <br /> z <br /> CD <br /> v <br /> CD <br /> :V1 <br /> �o cn z <br /> m c a) M M d c CD <br /> off H * m <br /> z o o'`D D 70 <br /> 0Cc <br /> ° — <br /> c <br /> CD <br /> 1- �. ....1..7....... ... <br /> Signat re of Owner o Agent Date C <br /> X 70 <br /> Remarks T : ` '• M <br /> m <br /> ........................................................................................................ o.................................................... <br /> : 00000c^'nm <br /> Inspection Date ....................................... /�Tzlo'•••••.. .. ... .9....�inis <br /> o 0 0 0 0 o m <br /> Zonin Aor o 0 0 0 0 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 Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />