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-,y <br /> Burnett County Office of Zoning Administrator � CD �o 0 <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 0 d <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD m <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. I a 0l <br /> rt <br /> / a 0 <br /> lfe .STEw.� — �v �^ Ci✓lo A y <br /> kV/. ............................ 7..................................... ......�/1`...?1r!7�......c J 1�. ................................................ � <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m cc <br /> F?/�NG3i✓f <br /> ADDRESS ........................................ B T <br /> ADDRESS <br /> ..�CS ,=�L .....�-�a <br /> •3 . <br /> ADDRESS <br /> .......... <br /> ADDRESS ADDRESS .b <br /> ................................ <br /> PHONE PHONE <br /> ............. <br /> PLUMBER WELL DRILLER <br /> .......... . <br /> ADDRESS ADDRESS <br /> rt < :a <br /> ............ <br /> . ................................................................................... ..PH.........ONE..................................................................... 'z N <br /> PHONE y <br /> DESCRIPTION 4. Sanitary Facilities: ° o : 1 <br /> 1. Work: No. Bathrooms v <br /> 2. New Building Details •••••• •• 0 <br /> New Building No. Bedrooms 'n <br /> Type of Construction: CD <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 ':.......................................... e <br /> GradingSlope .......................................... : <br /> Mobile Home 3. Use (describe exactly, 1 family <br /> Perc. Rate ................................... <br /> .......... <br /> Privy .......... home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench .......... <br /> .................................................... <br /> Subdivision ✓ Privy .......... <br /> .................................................... . . <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- N <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road C: <br /> setback, side and back 6 <br /> 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 /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --------- ----------------- -- � <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. <br /> Cn <br /> I &2CD <br /> 0 <br /> LO <br /> I � N <br /> L' <br /> z C <br /> � o <br /> La <br /> La <br /> m <br /> r �C (nmz <br /> CD 0C � <. CD � c CD <br /> * <br /> CD Q Q< — rr Q <br /> v <br /> �p C ' 0 m <br /> z o o fD <br /> o <br /> l7 \I 0 70 <br /> s .T6401.� �ye3 p <br /> .. _ <br /> Signature of Owner or Agent Date NC oo ° C <br /> S' '. .......................................................................................................� QQ • : M <br /> Remarks ..... 1............ .. ................I '..°.. m m <br /> m C <br /> m <br /> +fl <br /> ......................................................................................................... . ......................... ................................................. tQ <br /> n:`) OCNSIT <br /> Inspection Date ....................................... ... , ?I� o 0 o m <br /> J.................. 000000m <br /> Zoning Administrate 0000000 <br /> VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <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 /> 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 />