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Burnett Courrty . F Office of Zoning Administrator 3 M 0 0 <br /> . APPLLCATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as y .O <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD c :J <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> a <br /> m <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a ^ M <br /> n ,•(� <br /> ..�..kl..........D.e.4 y......... ......sS..�'........... ............................................................................................ <br /> ADRESS ADDRESS <br /> ...fi......... ....... .........S..�..Ifl. ............................................................................................ <br /> ADDRESS ADDRESS ;1 <br /> ........................... .............................................................. ......................................................................................... <br /> PH.ON PHONE Q <br /> .... .. .... .......... ... ...................................................... Q <br /> PLUMBER. WELL DRILLER <br /> ....................................................................... ............................................................................................ <br /> ADDRESS ADDRESS ;Q <br /> ' 0 0 <br /> ct <br /> PHONE PHONE Z y r <br /> DESCRIPTION 4. Sanitary Facilities' / ° g o <br /> No. Bathrooms / v <br /> 1. Work: 2. New Building Details '`{� 0 <br /> • o <br /> New Building ..�.. Type of Construction: No. Bedrooms m <br /> Q vM —Q Septic Tank Size Gals. < <br /> Addition ......... .r............... <br /> Sanitary ... Size ... .y.... ft. x . .. ... ft. ' `5©' <br /> Filling ...... ... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... o <br /> .......................................... <br /> GradingSlope .......................................... 0 <br /> Mobile Home 3. Use (describe exactly fa Perc. Rate ................................... <br /> Privy ....... .. home,garage,motel,etc.1 Dry Well .......... <br /> x.. .. <br /> Seepage Trench .......... <br /> Well . 'V <br /> Subdivision Privy <br /> Seepage Bed <br /> ------------------------------------------------------------------1 / <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road ^ a <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- f <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING G1 Yi <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :7 0 <br /> ---------------------------------------------------------------------- ?Cj <br /> 5. Lot Size: Fig. A. 6. Location: �Q p <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... Ri <br /> _ CDn <br /> Oo <br /> 0 <br /> -0 <br /> CD <br /> 1 . <br /> 0 <br /> N <br /> n c m <. co c <br /> ID <br /> m. N Q Q� — <br /> l�e �. �. <br /> Z oo'm <br /> o <br /> cn <br /> p b <br /> ... ..�.�... o <br /> p <br /> Signat e of Own or Agent Date 7 X <br /> CD <br /> �y�..1c ...-... ... r ..t±�. /9�7 <br /> Remarks <br /> CD <br /> ........................................................................................................................................................................................ -- <br /> u <br /> ........................................................................................................... .......................... . .............................................. °0 <br /> Ln <br /> InspectionDate ....................................... .. . ............... ... ........... .......... .�................ E�Oi o 0 0 0 0 o m <br /> ZoningAdm r o: 0000000 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing 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 />