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S rl-� C�'l 60 � Z <br /> Burhe�County Office of Zoning Administrator �, ° <br /> ° o <br /> w. 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 y °+ ••oj� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. CD <br /> :LA ' <br /> . ... . J..:�?..4,0.e.r4.................................. G".1/TF � <br /> .......... .. .... .......... ....... ; � <br /> r+' <br /> OWNER (pleas Intl CONTOR or SURVEYOR or NT a CD <br /> .............. ....................�... ...................................... <br /> ADDRESS <br /> ADDRESS '+ <br /> .......... V <br /> ADDRESS ADDRESS IY <br /> ............ 1 <br /> PHONE PHONE <br /> .......... ... f <br /> PLUMBER WELL DR..ILLER <br /> A...DRESS.... .................................................................................. <br /> ADDRESS D <br /> m L) <br /> c o <br /> ........................................................................................... ......................................................................................... O ,-i <br /> PHONE PHONE � <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> New Building No. Bedrooms ° <br /> ......... Type of Construction: m <br /> Addition ......... � <br /> ...................... ........................... Septic Tank Size Gals. .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling „•,•,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... ` r— <br /> Grading .......... Slope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench .......... <br /> ...................................................Subdivision Privy <br /> .......... . . <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- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o' <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... c <br /> Cn <br /> h <br /> ( 3 0 <br /> 0 <br /> T <br /> CD <br /> 0� O :C� <br /> ^vim a� <br /> 7 <br /> CD <br /> m1 <br /> cr �� fn 00 Z <br /> �. m d c m <br /> X o 6F.: � m <br /> ° m m <br /> s � m <br /> �t = <br /> .......................................................................... : : <br /> signature of Owner or Agent o C <br /> Date <br /> J 6� <br /> X 70 <br /> 3emarks -n .N CD <br /> ....................................................................................................................................................................................... <br /> . .. ........................ .................... <br /> ... .. .................... <br /> nspection Date ....................................... Q�r d!!, ;1O c o 0 0 C 0 Ln m <br /> Zonin A -ministrator :� g o 0 0 0 0 0 <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> afore 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 /> g 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 />