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/� <br /> •P,f p...,�..h'q 11 <br /> Burnett County Office of Zoning Administrator c - --1Z <br /> APPLICATION FOR SANITARY LAND USE BUILDING PERMIT `\ <br /> 3 1 <br /> 3 � <br /> o :O <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y — :V <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c Ncl <br /> CD <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 Q �JJ <br /> h � .�O <br /> .s......../ .........��%Xe.r... n. .e.n..... .. /y1! .a�.�ie� '....................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> y <br /> u. ....... .... QX., ®d......... ... .� <br /> ADDRESS ADDRESS <br /> ........................................................................................... . ... ... ................................................................................ <br /> ,ADDRESS A..DDRESS.. . <br /> .. ., .-.. ..asV............................................. <br /> PHONE PHONE :off <br /> .......... w <br /> PLUMBER WELL DRILLER "<3 <br /> ................. <br /> .......... 0 <br /> ADDRESS ADDRESS <br /> h o <br /> ........... z o <br /> PHONE PHONE <br /> DESCRIPTION 0 <br /> 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms vo <br /> New Building Typ of Construction: CD <br /> No. Bedrooms <br /> Addition f,Q, ,,,,,,,,,,, Septic Tank Size Gals. ......... <br /> ... .......... ... <br /> Sanitary .......... Size .......��. ft. x ...A.V. ft. .......... <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> e <br /> Moving .......... Area ........................................... Soil Type .......... 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 /> n . <br /> ../7��f..................�......... � Privy � <br /> Subdivision E Sfrit �j ......•••• V <br /> Seepage Bed .......... <br /> ----------------------------------------------------------------- ---- t <br /> cn <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 yard dimension and location and setback from all bodies of water. If property is located at a highway inter- fl <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 /> o <br /> 5. Lot Size: // /g Fig. A. 6. Location: 0 <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> —� to <br /> CD <br /> N O <br /> o <br /> : t 3 <br /> -n �. <br /> CD <br /> cCD CD <br /> CD Q- <br /> N '� G m <br /> Z 00 CD m 7p <br /> o <br /> can � 9 <br /> � <br /> � p <br /> .... ............../.1193..... o <br /> Signat�u*re of ner or Agent Date <br /> 7 <br /> Remarks . . r � .. 1.�.7..t -„ <br /> - <br /> CD <br /> ........................................................................................................ .. ........................................................................... \fs -n <br /> Inspection Date ....................................... ??22.7. .... ..........'............ ................... <br /> 00000,cNnm <br /> Zoning Admi istratorJ o 0 0 0 0 o fmll <br /> DOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> iefore 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 />