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n. <br /> Burnett County Office of Zoning Administrator � _ -� Z <br /> o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT � 3 <br /> v ;W S <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H -.h . <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use - c 4' <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. C <br /> CL <br /> z .. �zsr , .... qke...i..:�1...F N o <br /> ..... kl- ...... .... ........................... .......... <br /> ... . ...... ... ...................................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> Q <br /> Xa .., ,.�LLI ............. ^ <br /> ADDRESS ADDRESS <br /> ADDRESS ADDRESS <br /> .................................. <br /> PHONE PHONE <br /> U.7T-,. ............................................................. <br /> ..... ......................................................................................... o <br /> ADDRiESS ADDRESS — <br /> '. <br /> PHONE PHONE <br /> DESCRIPTION o r <br /> 4. Sanitary Facilities: o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ......•••• <br /> New Building „•( Typ -of C$nstruction: No. Bedrooms <br /> Addition ���`� C Septic Tank Size Gals. ..........� <br /> .......... <br /> Sanitary Size ...� .... ft. x ... ..... ft. <br /> Filling •.....•... Hei ht/..a. Stories ..... . 4a. Absorption Field Site: <br /> 9 �........ p <br /> MovingArea Soil Type .............................................................................. p �: r <br /> Grading Sloe .......................................... p9 ° <br /> Mobile Home 3. Use (describe exactly, 1 family Perc. Rate ................................... <br /> Privy ...... home,garage, motel, etc.) Dry Well .......... <br /> Well Seepage Trench .......... M <br /> ...................................................Subdivision Privy ......... <br /> Seepage Bed <br /> ---------------------------------------------------------------------- o <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road Irl 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- <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 /> 0 <br /> ---------------------------------------------------------------------- Ci <br /> 5. Lot Size' Fig. A. 6. Location: <br /> ft. x ft. — <br /> ............... .............. ...... .............. sq.ft. <br /> 'oCD <br /> C <br /> O o j. <br /> _. <br /> led <br /> •v T! <br /> --_ o <br /> _ <br /> I <br /> M En r-:P Z <br /> n 6 7 <. �p = C CD <br /> m aa•< — ;.Q � <br /> i3 CNri <' ° a 0 'O <br /> p y; G cn M <br /> o 03 Cb <br /> vj 5' <br /> CD . <br /> ;p o <br /> o <br /> G� .../. <..�...�.............................. :� <br /> �7...�f1, ........... . : . m <br /> signature of Owner or Agent Date 'J ° C <br /> X <br /> iemarks -n c m <br /> m 0 <br /> ...................................................................................................................................................................................... <br /> ...................................................................................................... <br /> Io' cA <br /> nspection Date ....................................... �........... o... NJ m <br /> g o 0 0 0 <br /> . .......... . . . ........................ <br /> Zonin Adm istrator . . 0 0 0 0 0 0 cr"n <br /> OTE: 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 /> is application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> th 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 />