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Burnett County Office of Zoning Administrator C - � z <br /> 0 0 <br /> APPLICATION FOB 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 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseCDc <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> .i. ......c��. . .11...................................... ........................................................................ y <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a v CD <br /> h. .�.ij.f.. �.�,►(. .................................. ........................................................................... a 7E <br /> ADDRESS ADDRESS <br /> m <br /> ........... t <br /> ADDRESS ADDRESS <br /> �. <br /> PKNE <br /> ... PHONE�1h.S.................................................. <br /> ............................................................................................ 4V <br /> PLUMBER WELL DRILLER <br /> ................../........................................................................ ............ 0 <br /> ADDRESS ADDRESS CDo <br /> (JV ; <br /> ........................................................................................... ....H.ONE.... ................................................................................... o <br /> PHONE P <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •�•••• <br /> 9 <br /> No. Bedrooms ........ <br /> New Building Type of Constrution: ; <br /> Addition „••... <br /> Sanitary .}t1.3.((,h• , •••,•..•.•.. .. Septic Tank Size Gals.., Size .............. ft. x ..�......... ft. 7�_... <br /> ••� : <br /> Filling •......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... r.......................................... ;= o <br /> Grading ......... Slope .......................................... <br /> Mobile Home .......... 3. Use (describe exact) 1 -fal Perc. Rate ................................... <br /> Privy „•••••, home,garage, motel, etc.) Dry Well r <br /> Well „••, Seepage Trench .......... rn <br /> .................................................... <br /> Subdivision .......... Privy j.. <br /> Seepage Bed <br /> ----- ----- --- ------ — ------------ <br /> :C C/) <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- !� <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> \ H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ------------------- ---------------- ------------- ------- ( n <br /> 5. Lot Size: Fig. A. 6. Location: fK, <br /> f� <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... :r <br /> I CP <br /> r. <br /> N o <br /> m I, <br /> 01 <br /> 0 <br /> N <br /> 7 <br /> CD <br /> :r <br /> M cnr �� cnooz <br /> 'D ID CD <br /> < - a <br /> -o cn < � : ° �' � -0 <br /> y* p y G co M <br /> z o S. <br /> fD m 7p <br /> o -:3 �. <br /> o � <br /> CD p <br /> .....4oiw�ner <br /> .............................................. ...................................... 4- <br /> X <br /> c_ <br /> Sign tur or Agent Date <br /> Remarks (�.:.�?..� .< y ....0 cIi _ Tm <br /> ....................................................................................................................................... m <br /> CD <br /> to <br /> ..........L%.........................-! " / . :�� - ............................................................................................................... n <br /> . .. <br /> � � � � m <br /> Inspection Date .. ...7.. ./ ......... u2 �21�) fjh[ r� :�Q o 0 0 o cn <br /> ...:..r�:.......... . ................................ : 11 coo oom <br /> Zoning Adm nY istrator.t J c o o 0 o c/) <br /> VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary face ities <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 />