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Burnett County � <br /> Office of Zoning Administrator 0) � o 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 o <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. 3 a <br /> I,�/ �' - <br /> ....... . ...�................ - <br /> .... . �.....z:.�................. l`�r �.. ...i.s.. �....... ..t��L -�.��. <br /> OWNER (please print) y v <br /> �,/ CONTRACTOR or SURVEYOR or AGENT C <br /> ....1.. .. ..... .. ' l. ...., .i� ��.................... <br /> ADDRESS a <br /> ADDRESS <br /> ). <br /> ADDRESS ......... ...J............-.......... .................. <br /> v <br /> ADDRESS <br /> 'HONE `. <br /> PHONE <br /> 'LUMBER . ... .......................................... y <br /> WELL.. D..RILLER <br /> ............................................................................ ...... . ............................................................................... <br /> ADDRESS <br /> 4DDRESS <br /> �t o <br /> P. <br /> 'HONE ..ONE....................................................................................... o + <br /> H <br /> DESCRIPTION z H r <br /> 4. Sanitary Facilities: ° o 0 <br /> I. Work: ra: <br /> 2. New Building Details No. Bathrooms <br /> New Building E 0 <br /> Type of Con;truction: No. Bedrooms <br /> Addition --X .W�'C Septic tic Tank Size Gals.Sanitary .......... Size ....Z{1.... ft. x ...Z.4!..... ft. � <br /> Filling .......... Height...fir....... Stories . .1.......... 4a. Absorption Field Site: '- <br /> Moving Area .......?. ..V- -.. Soil Type .................................... <br /> Grading : <br /> .......... Sloe ................... o....................... <br /> Mobile Home <br /> .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... ?� <br /> Privy .......... home,garage, mgtel, etc.) Dry Well NIC <br /> Well ..........0 G :z'e..!.�.c .................. Seepage Trench .......... <br /> Subdivision Privy , G1 <br /> ......................... <br /> _____ Seepage Bed <br /> ocation of proposed structures and existing structures well,sewage systems, roads etc., should be sketched in Fig. A. Include road I � <br /> )tback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- n a <br /> action, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r <_ <br /> TRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. y <br /> -------------------------------------- o' <br /> -------------------------------- 7 <br /> Lot Size: Fig. A. 6. Location: <br /> 7'...;�.CJ..... ft. x .. Sc.... ft. - ...r�. ............. c <br /> tCD <br /> � � <br /> �b <br /> \'� / • X <br /> � 3 <br /> CD <br /> z <br /> ® 0 <br /> CD <br /> � 2, <br /> �7 -1. C car- � � � z <br /> J1 V CD <br /> t QQ — ,;+ p <br /> m <br /> m <br /> o, n -� <br /> iature of 0 n r or Agent Date f e <br /> rr x �o <br /> iarks ......................................................................................................................................................................... � ; <br /> :o <br /> ....................................... ..................:.......................................................... .. <br /> oo :1c: _ _ ( AN <br /> ` TI <br /> section Date ................................. <br /> ...... � . !C�. z'. .�� o 0 0 0 o cn m <br /> Zoning Admi ifS strator 0 0 0 0 0 0 0 <br /> -E.- A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> re construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> 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 /> I 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 />