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Burnett County Office of Zoning Administrator -+ <br /> 0 0 <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 '< H ° ;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 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> OW R (please print) CO TRACT or ... <br /> SURVEYOR or AGENT - a <br /> ADDRESSL�K[•1*f.•�......:•...1. ....I-. dU. . . . ...�.......�v j... . . . .........., /..........�� <br /> ADDRESS <br /> Zv/` � � � � <br /> .... ............................. ....................................... .......................................................................................... '�1D <br /> ADDRESS ADDRESS \ <br /> ... PHON.E................................................................................ <br /> PHONE y <br /> WELL DRILLER <br /> ............................................................................ .......................................................................................... ' <br /> ADDRESS ADDRESS <br /> m G) <br /> h 0 <br /> .................................................................... <br /> PHONEPHON.E........................................Y....................................... o <br /> DESCRIPTION o o <br /> 4. Sanitary Facilities: o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •••�••••• <br /> o (� <br /> New Building .,,� Type of Construction: No. Bedrooms ' 0 <br /> (� <br /> Addition •,•,•••••, •••„••,• ... ,••••,•..•.•,,,•.••. •••.•• Septic Tank Size Gals. <br /> Sanitary 6rx— 3 <br /> Y ..... Size ..�- ..... ft. x ....... ...... ft. .�: <br /> Filling 4a. Absorption Field Site: <br /> .. ....... Height...�.. .... Stories ...f.......... p <br /> Moving Soil T r' ' <br /> 9 .......... Area ...1..3. 3t........................... Type ............................... .... N: :` f r <br /> M �\J <br /> Grading Slope ....................................... .. 0 <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... k :v <br /> Privy .,•„•.... home,garage, motel, etc.) Dry Well .......... <br /> Well ••.�C ��— Seepage Trench <br /> Subdivision .......... Privy .......... <br /> ....................... <br /> Seepage Bed <br /> -------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q Q <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING N <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ———————————————————————————————————————————————— <br /> 5. Lot Size: Fig. A. 6. Location' <br /> ft. x .............. ft. — C ..P.Q..�%........ sq.ft. hit.: r/ . <br /> c <br /> .................................. <br /> Cn <br /> n <br /> Y 0 Q. <br /> Lo <br /> L --� <br /> 0 <br /> _. <br /> 4" <br /> D <br /> rn r cn W <br /> m v _ c M <br /> m. r j 0--<+' 0- <br /> o cn < <br /> Z (Q <br /> O �< <br /> O <br /> 0 <br /> .. .... ......... ................... ....� .... - ....... <br /> o C <br /> erg ture f Owner or ge t Date <br /> emarks ..J........:... ....?.!:�.. .... a�. ................................................................................................................ _ m <br /> CD <br /> m <br /> ...................................................................................................................................................................................... W <br /> ...................................................................................................... <br /> � <br /> �spection Date ....................................... t1�7� �$ : 1 00000vrm <br /> " 0000bo <br /> ZoningAdmi strator��� 0000000 <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 />