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Burn- County SCANNED Office of Zoning Administrator �° 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- � 1 <br /> e.ri !l.1/..... .. . . O........ ...... ..... ........................ <br /> OWNER (pleas Intl CONT CTOR or S RVEYOR or NT <br /> a <br /> G <br /> ADDRESS ADDRESS � <br /> .......... <br /> ADDRESS ADDRESS <br /> ............. ............. . . . <br /> PHONE PHONE <br /> ........................................................................... . . ...................................................................................... <br /> PLUMBER WE.. ..LL DRILLER <br /> .......... <br /> ......................................................................... ADD.......R....ESS...................................................................... f0 <br /> ADDRESS cD 0 <br /> n o <br /> ...................................................................... PHONE........................................................................................... Z o r <br /> PHONE � • <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building Type of Construction: No. Bedrooms L '• <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 .................................... r <br /> .......................................... <br /> Grading Slope .......................................... : o 0 <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage,motel, etc.) Dry Well .......... <br /> Well Seepage Trench .......... <br /> .......... .................................................... <br /> Subdivision Privy <br /> ........ .................................................... <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------- cn <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc.,should be sketched in Fig. A. Include road c <br /> 6 <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. H <br /> o' <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> ( 0 o. <br /> 9J v <br /> 9y� � 9s- _qj y <br /> rt 0 <br /> CD <br /> o Z <br /> cnr -u cncoZ <br /> W CD C d 2. CD C fC <br /> T. rj a a� — '•i CL <br /> .W <br /> p Z 00 j CD G cn CD 77 <br /> G b Ob o <br /> o <br /> C m <br /> 4- <br /> CP <br /> o � <br /> o C <br /> Signature of Owner or Agent Date <br /> J � <br /> X 70 <br /> Remarks -n m <br /> ` ` 0 <br /> CD <br /> CD N <br /> ........................................................................................................................................................................................ u <br /> ...... <br /> rC...J................... <br /> : O NM OOSImIns Inspection Date ....................................... ................. I1pe 8 000000m <br /> Zoning Administrator CD 0 0 0 0 CD fn <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 />