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1 <br /> Burnett County Office of Zoning Administrator C - z <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 � <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 /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 CD <br /> a <br /> o <br /> ................................ ............................... ....�.............................................. H <br /> OWNER (please prim ) CONTRACTOR or SURVEYOR or AGENT m CD <br /> ................................................../........................................ .......................................................................................... <br /> ADDRESS ADDRESS <br /> AD.. <br /> ........................................................................... . ... ............................................................................ <br /> ADDRESS DRESS........ <br /> PHONE PHONE <br /> ............................................................................ ........... .............................................................................. <br /> PLUMBER WELL DRILLER <br /> t <br /> ADDRESS ADDRESS <br /> CDo . � <br /> PHON.E........................................ ....................................... o p 141 <br /> PHONE z N <br /> DESCRIPTION 0 <br /> 4. SanitaryFacilities: o ° <br /> 1. Work: <br /> 2. New Building Details No. Bathrooms .••...... <br /> New Building Type of Construction: No. Bedrooms °c <br /> Addition R /�C Septic Tank Size Gals. .......... <br /> ........ <br /> Sanitary Size .. ft. x ....Z.y. ft. : G <br /> Filling .......... Height.... ....... Stories .... ........ 4a. Absorption Field Site: <br /> Moving .......... Area .......5�.7..�°....................... Soil Type .................................... t 1 <br /> Grading .......... Slope .......................................... <br /> o <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy ......•... home, motel, etc.) Dry Well .......... <br /> garage, <br /> Well Seepage Trench .......... t,�y <br /> Subdivision .......... .................... Privy .......... :fi <br /> Seepage Bed <br /> -------------------------------------------------- ------------ <br /> N <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road t <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 /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Q <br /> p <br /> 5. Lot Size: �D v Fig. A. 6. Location• <br /> ft. x .............. ft. — ............................... sq. ft. �.:.g. .... .`.. ......U- 973........ <br /> C� <br /> CD <br /> N ° <br /> ASS Ae /d o <br /> 0 <br /> CAP o <br /> y �r� <br /> >v C�`qflA� <br /> F' usr o <br /> a <br /> CD <br /> qL <br /> \ Cn <br /> cn m <br /> t V, LD. r ao < _ — a � <br /> r <br /> -0 oy; c : � < � gm <br /> z oo `D � fD70 <br /> �{5-S <br /> o <br /> :.�.v............. ................. �� <br /> m <br /> �. ....... o p <br /> igna e of Owner or Agent Date _ <br /> X i 70 <br /> emarks ......................................................................................................................................................................... T m <br /> CD <br /> CD <br /> v <br /> ..................................................................................................................................................................................... <br /> Ispection Date ....................................... 2ryceQ. ....— �......J 4 0 0 0 0 o cii "m <br /> Zoning Ad inistrafor o 0 0 0 0 0 Cn <br /> )TE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> s application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> h 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 />