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Burnett County Office of Zoning Administrators . <br /> 0 0 <br /> ..,- "'APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT ;7+' 3 � <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 UseCD c '`ll <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 (D <br /> I l e C - �ay � o <br /> ......p p.............:.....G...rch ............ mp,:u� 1 ..�.. . . Center. ............ 'OWNER ( lease rint) CONTRACTO SURVEYOR or AGENT cec <br /> . ...... �...�....:�. N:.i ................ ��7.... .o....... .: <br /> r/ r <br /> DRESS <br /> R ESS <br /> �. <br /> ADDRESS A DRESS <br /> .�.. ...--... s -.t ...a:.-�.......................... ... ..!...� ... .8. .-... , .. ............. <br /> PHONE PHONE :^ <br /> PLUMBER WELL DRILLER �.J <br /> .............. <br /> ADDRESS ADDRESS � o l <br /> ............................................................. — <br /> PHONEPHON.E........................................ ....................................... o � <br /> DESCRIPTION o <br /> 4. SanitaryFacilities: 0 0 <br /> 1. Work: No. Bathrooms ` T <br /> 2. New Building Details •••'•••••• .- !!1 <br /> New Building ...., Type of Construction: No. Bedrooms .......... ti <br /> Addition — Septic Tank Size Gals. ;.......... ...............lf.. ... <br /> L o [ <br /> Sanitary Size .2..... . .. ft. x ..!��. ft. <br /> Filling 4a. Absorption Field Site: <br /> ........ Height.�... ... .. Stories ........ .. .. p <br /> Moving `` c : r <br /> Area ...1�.?r..... . . ... .. Soil Type .................................... : <br /> Grading .......... .. Slope .......................................... �V <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy Dry Well <br /> home,garage, motel, etc.) <br /> Well .......... �a1 r0.92 Seepage Trench �' <br /> i1 <br /> Subdivision ......... Privy <br /> .....�.�.mod......... .......... . <br /> Seepage Bed <br /> ------------------------------------------------------------------ <br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc., should be sketched in Fig- A. Include road iiz 6 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 `u < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 0' <br /> ---------------------------- -------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> �n Cn <br /> J 0 <br /> CD <br /> N p' <br /> O <br /> nn 0 <br /> 1� <br /> _S <br /> 0 <br /> d <br /> m <br /> N d0 �cnmz <br /> CD <br /> Gto m <br /> Z 0 0' ID <br /> o — <br /> .. ........ .... ... . ................. .... <br /> 6..�.... ... �° : . . . . . <br /> m <br /> p <br /> Signature of Owner or Ag t Date " '\ ° C <br /> Remarks ..... . -n 70 <br /> � �h .....11..rv.. �L�C�................. � x v <br /> .. .�. ......... .... . .I..........= <br /> C <br /> n <br /> � � NT1 <br /> Inspection Date ....................................... : 'X: o 0 0 o cn m <br /> ;9............ .............................. ��ki 000000m <br /> Zonin Admi strator 0000000 <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facili 'es <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 plumhing 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 /> iith 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 />