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C'z--)1 C--7� <br /> Burnett County Office of Zoning Administrator C - o z <br /> 0 o <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 < H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use -CD <br /> c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> �lx.. ... .......... . .... ............ ,�.. ...�.. _ o <br /> F <br /> d <br /> 0 <br /> OWNER ( lease pr t) CONTRACTOR or SURVEYOR or AGENT CDm <br /> L. <br /> ..............� ✓f:�:......... ..... <br /> o_ <br /> C <br /> ... <br /> DREG ADDRESS — <br /> QCD <br /> ..........s..........................�. .' <br /> ADDRESS J ^; <br /> ADDRESS � <br /> ............................................... ......................................................................................... <br /> PHONE PHONE <br /> .......... 'W PLUMBER D ILLER <br /> ADDRESS ����SSSS — <br /> c� <br /> 0 <br /> PHONE PHONE rt <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... <br /> New Building No. Bedrooms �' o <br /> Type of Construction: '0 <br /> �. m <br /> Addition Septic Tank Size Gals. <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling4a. Absorption Field Site: <br /> .......... Height............. Stories ............... p '-- <br /> Moving ....... Area Soil Type .................................... r '............... ....................... . <br /> o <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 /> ... ...... ................ <br /> Subdivision Privy <br /> .......... .......... <br /> .................................... <br /> -------------------------------------------------- Seepage Bed------------ � .N <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road (,J 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- Q <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. <br /> -------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x ft. c <br /> o <br /> d CD <br /> IV 0 <br /> o <br /> Lo <br /> \ >'j- 7 <br /> : I � <br /> m <br /> o <br /> m <br /> �n <br /> f CD <br /> 6 •\ <br /> �o to r toCD C <br /> m z <br /> cc, N Q Q< <br /> pH.0 m <br /> o o? `° fD70 <br /> No <br /> ID M <br /> .: .... ... ...... ............... . .. ...�... G� .rr ............... s c <br /> atur of Owner or gent D e <br /> mas ....................................................................................................................................................... - m <br /> . .. 00000cNnm <br /> mtionDate ....................................... ........... ............................... 000000m <br /> // Zoning Admin strator o 0 0 0 0 o cn <br /> E: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> re construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> intil a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> WER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />