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C`Y1..CI-I-r 011 <br /> Burnett wounty Office of Zoning Administrator d -0rCD <br /> o 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 , o <br /> shown herein'The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m r <br /> Ordinance, Sanit�ion Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 CL <br /> CsARy / , = CL <br /> vJ \_ <br /> ..............p... .L...... .T..�il�..!� ..o... .N........ 5.��.�-. . .. y... . .............................................................. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT aY�CD <br /> i. CD <br /> � . .�!.e. .rA�'C..�....c ..i'.s......s' 3�.. Q <br /> ................................................................................ <br /> ADDRESS ADDRESS <br /> ,a .. ....................................................... ......................................................................................... <br /> ADDRESS ADDRESS <br /> ..................... P..H..ONE....................................................................................... <br /> PHONE <br /> .................................................. ......................................................................................... <br /> PLUMBER WELL DRILLER �V <br /> ADDRESS ADDRESSCD <br /> CD <br /> oy <br /> I <br /> PHONE PHONE 0 �+ ,. <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o �`° b <br /> 1. Work: No. Bathrooms <br /> / 2. New Building Details ••••••••• � �• <br /> New Building 4"" No. Bedrooms .. °a <br /> Type of Construction: ' <br /> Addition kay........, Septic Tank Size Gals. ��E� :6\ <br /> ? L.Sanitary Size ..'V..R.... ft. x ..... <br /> Filling .....•.... Height..........;.' Stories ....I.......... 4a. Absorption Field Site: ?.p <br /> Moving 9...... .�t..F..T..:... Soil Type ...............J�.�Nl� : :Z <br /> Area ........Sad r <br /> Grading Slope ...................... ......... ° <br /> Mobile Home , 3. Use (describe exactly, family Perc. Rate ....................,{.......... � <br /> Privy ome motel, e c.1 Dry Well <br /> Well .. C�x9�`<..!�'-. ..t�.�d/pferl Seepage Trench .......... :Q <br /> garage, <br /> Subdivision ......... Privy I <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 � <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q <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. t <br /> o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: 4 a <br /> /.Q.4......... ft. x .s�. y.. ft. — D /r S IAJ S '�c�3,,..Y s ft. N...............................l.. .......................... <br /> Cn <br /> _y 0 <br /> N <br /> 0 <br /> O <br /> ka <br /> • �, CD <br /> v� t jdCD <br /> jai ��+ <br /> CD l Cn <br /> C N con Cn 7 G ry 7 C)IDTN a <br /> o NZ o o' fD0 <br /> o � � <br /> ........ .. ..... ..... .?^ .. �.. <br /> CD <br /> o t7 <br /> Signature o wne or Agent Date 0 C <br /> X <br /> Remarks .. .`X. �. .. .................................................................................................................................. - ` 0 <br /> m <br /> .... ............................................................................................................................................. - <br /> - II <br /> ........ ........ .. ..................................... <br /> � � NT+ <br /> Inspection Date - t� o u, <br /> o <br /> Zoning Admini for o <br /> OTE: 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 /> its application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> 'ith 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 />