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3urnett County Office of Zoning Administrator C - o z <br /> 0 o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> f0 THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as o <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c (� <br /> Drdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. CD <br /> ......:..�p.......> .�'! ............... ................ y o <br /> .. .� <br /> DWNER�ease print) ..OR �......................................... m <br /> cc<< I CONTRACTOR or SURVEYOR or AGENT a CD <br /> 91 ......�1 �9-i!. .�. ....... 4 5..... ............................................................................................ <br /> aDDFESS ADDRESS <br /> m <br /> ...............�............................................................ ............................................................................................ �O <br /> ADDRESS i N <br /> .......... <br /> ADDRESS <br /> 33 0 ,6 <br /> .................................................................... ............................................................................................ <br /> 'HONE PHONE <br /> ....................................—, . ............ <br /> 'LUMBER WELL... DRILLER <br /> 0 i <br /> ADDRESS ADDRESS <br /> 0 o <br /> P H..ONE....................................................................................... o' <br /> 'HONE _ <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° ' <br /> I. Work: 2. New Building Details No. Bathrooms <br /> D <br /> New Building ........, Type onstruc ion: No. Bedrooms .. °c <br /> Addition Y 59�,,•/!�„�,,,,,,,,,,,,• Septic Tank Size Gals. <br /> �•�• <br /> Sanitary ......... <br /> .......... Size ....1. .. ft. x .... ... ft. <br /> Filling Height......` . tortes /- -fAr <br /> ...... 4a. Absorption Field Site: <br /> Moving .......... Area ..,'.�.�.1 .... Soil Type .................................... o <br /> Grading Slope .......................................... ; <br /> Mobile Home 3. Use (describe exact y, 1 family Perc. Rate ............................. ..... <br /> Privy .......... ho+m-e,garage,-rmote etc.) Dry Well <br /> Well ��+C /v �O�C,� Seepage Trench <br /> d.....�a-4e......................... . .....Subdivision Privy <br /> ......... <br /> Seepage Bed .......... :\ <br /> -————————————————————————————————————————————————————————————————————— <br /> N <br /> .ocation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road <br /> atback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Cr <br /> action, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING -4 <br /> TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------- ----------------------------------- _ <br /> i. Lot Size: Fig A. 6. Location: <br /> . .),) . <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> 0 <br /> n <br /> o' <br /> 35 ° <br /> N <br /> 7 <br /> -n <br /> CD <br /> o <br /> 75 <br /> M cn r : cn Z <br /> CD C W ''. N C (D <br /> — o 0 3 `° 7D <br /> :O o <br /> :v CD p <br /> .............. ...... ...................................... /. /te <br /> : <br /> .. o igntureofOwner or Agent D �� ° C <br /> X 7� <br /> 'emarks -n : m <br /> CD <br /> ...................................................................................................................................................................................... . .`• <br /> . . . . . . <br /> ................................... <br /> e: <br /> o: „ � � J <br /> )spection Date ....................................... ........... .... . ...... o 0 0 0 o M m <br /> Zor. Admi istratorT� o 00 0 0 o cmn <br /> DTE: 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 /> 3 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 />