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eq—" c f7/i1f / <br /> Burnott County Office of Zoning Administrator � c <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 < y <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. CD C Jl <br /> .... . .......................... .....-- .. ..................................................... _ <br /> N O <br /> f.... . <br /> fD <br /> R (please int) CONTRACTOR or SURVEYOR or AGENT a ' M <br /> / w :vl <br /> ADDRESS ADDRESS ' ^ <br /> n �? 'V <br /> DDR 1 <br /> ......................................................................................... <br /> A S ADDRESS <br /> 1 <br /> �, .....--.... ..9 ..........3.s..... ........ <br /> PHONE PHONE <br /> .......... <br /> PLUMBER WELL DRILLER <br /> ............................................ ........................................................................... ,J <br /> ADDRESS <br /> ADDRESS �' f <br /> o' o <br /> PHONE PHONE N <br /> DESCRIPTION o 0 <br /> . Sanitary Facilities: f o <br /> 4 ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ....•.... <br /> New Building „••X,... Typ of Construction: No. Bedrooms ...6.... . <br /> Addition �P Septic Tank Size Gals. �3 <br /> P <br /> Sanitary '` J <br /> .......... Size pZ... .... ft. x ft. <br /> Filling .......... Height.... ..� Stories .....�........ 4a. Absorption Field Site: <br /> Moving .......... Area .....+.' � lC?... �...'f Soil Type ....6.............................. <br /> : <br /> ` <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 i <br /> i........................ <br /> Subdivision ......,, Q ...••.. Privy .......... (� <br /> Seepage Bed <br /> ------=--------------- -------------------------------------------- Vl <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road �� C 711) <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 t�• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: fw42&t." Fig. A. 6. Location: <br /> ft. x .............. ft. — ............................... sq.ft. ............................................................................... t <br /> Cn <br /> CD <br /> N <br /> o <br /> D <br /> 1 � <br /> 0 <br /> m <br /> . b`•t rpf ( z <br /> ZI n' o <br /> OUT 'V <br /> CD CD C CD <br /> m <br /> a cn <, C: 3'l7 'C <br /> z oy < �n m <br /> 0 <br /> o m <br /> b <br /> lelra............................... ... <br /> �C1 fD <br /> C/� m <br /> 1 p <br /> A ture of Owner or Agent Date C <br /> x 70 <br /> emarks ,,,, m , , v <br /> ..... .. . : . <br /> CD <br /> CD <br /> ....................................................................................................................................................................................... <br /> .......................................................................................................P .......... .....w................................... <br /> nspectionDate ....................................... '�'a °. ........... .......... �.................... . 0 0 0 0 <br /> Zoning Ad inistrato 0 0 0 0 0 <br /> 5 <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 /> ig 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 />