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Burnett Cour. y Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT h' 3 <br /> o <br /> TO THE 'ONING 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 c�c c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- �Q <br /> ./. xr..i..A.h0.G'......... �r................ <.. 'l�c.�.Z......l..User. .f'ti.,............I.............. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a CD <br /> (�!L J .e �C,.t...t-.7me.�1.t 1�...................... 'a c <br /> ADDRESS ADDRES / J M <br /> . .Ls.-ke -.y . ....................................... <br /> ADDRESS ADDRESS <br /> ....................................................................... PHON.E................................................................................ <br /> PHONE <br /> PLUMBER WELL DRILLER '•�� <br /> ADDRESS ADDRESS <br /> m 0 <br /> c o <br /> PHONE ?' <br /> PHONE Z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Construction: No. Bedrooms .......... D <br /> Addition Septic Tank Size Gals. <br /> .................................................... . . <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> MovingSoil Type .................................... <br /> .......... Area ........................................... Yp r <br /> o <br /> Grading .......... lope .......................................... �. <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench ...I...... '• <br /> ....................................................Subdivision Privy .......... <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 C <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 /> o' <br /> ---------- -------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> rCD <br /> cn <br /> cc <br /> �s <br /> 0 <br /> N <br /> .T <br /> (^j 0 O <br /> fy <br /> (D <br /> cnr - cncoZ <br /> ° 23 :!. dECD <br /> CD Cy- <br /> Naa< — '; a <br /> A -o cn <:C : �' S' 0 'V <br /> Z CD <br /> �I '• �� <br /> J � o <br /> Signature of Owner or Agent Date ° _ <br /> X <br /> Remarks m c ? my <br /> - <br /> ........................................................................................................................................................................................ CD <br /> — <br /> ........................................................................................................................................................................................ <br /> W Efl <br /> i. <br /> v� <br /> Inspection Date o 0 0 0 o crl m <br /> Zoning Administrator $: G o 0 0 0 0 o 0 <br /> VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> )efore 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 />