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Burnett County Office of Zoning Administrator C - o Z <br /> _ . o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT h <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 UseCDCD <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> .. '..L. ......... '!. .�..�. F f G n Y - o <br /> .................................... .......d A.k.........�0.....5... <br /> C <br /> OWNER (please print) <br /> P CONTRACTOR or SURVEYOR or AGENT CD <br /> a <br /> �..!. .........5............. ............N..h. ...lel.. ......... . ............ ..................... <br /> ADDRESS ADDRESS <br /> . . ............................................................................ <br /> ADDRESS ADDRESS <br /> .. ..................................................................................... <br /> PHONE PHONE.... <br /> ......... .................. ................................................. D .................................................................. <br /> PLUMB..E..R WELL RILLER <br /> .D...R...ES..S.............................................................................. <br /> ADDRESS AD m <br /> h o <br /> ........................................................................................... ............................................................................................ •� y ' <br /> PHONE PHONE o <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: o° ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> 0 <br /> New Building Type of Construction: No. Bedrooms <br /> Addition r/• ..... -lf R�s��.... . Septic Tank Size Gals. : <br /> Sanitary Size .....41....... ft. x ...... ...... ft. .......... <br /> Filling g 4a. Absorption Field Site: <br /> .......... Hei ht...A/...... Stories ......I....... <br /> Moving .......... Area ......W.✓2.... y..J-1................ Soil Type .................................... : r- <br /> Grading Slope .......................................... <br /> o <br /> Mobile Home Perc. Rate ................................... <br /> .......... 3. Use (describe exactly, 1 -family <br /> Privy .......... home,garage, motel, etc.) Dry Well <br /> Well ( ,;t Seepage Trench <br /> L n....�fRG.e... .r.V..l... . !e°..U <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- <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. `- <br /> 0 <br /> ---------- ------------------------------------------ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ........ ft. z_. ��.a... ft. — ............................... sq.ft. ............................................................................... <br /> CD <br /> Cn <br /> N <br /> o <br /> L A e ,`� A 0 <br /> = <br /> Z <br /> .-F <br /> %X1� P RoPose � � '` 0 <br /> r J <br /> r�'l6 tla0, o <br /> �- �--T o <br /> CD <br /> f <br /> ~n n 6 = < CD7 C'cD <br /> 1 m NQa•G _ rt = � <br /> 'O Ul <. <br /> m <br /> Z o o `D m 70 <br /> :w o <br /> a m <br /> .. . ....... ..................... >5...-.. ... - w o c <br /> ISa of O ner or Agent Date _ <br /> X <br /> Remarks ......................................................................................................................................................................... „ mCD 0 <br /> CD <br /> ........................................................................................................................................................................................ -- <br /> ....................................................................................................... .. ...................................................... <br /> o: <br /> Inspection Date ....................................... ?!'kQ. <br /> ............�.. ..... ..... ..../.t::�........... o 0 0 0 o cNn m <br /> Zoning Adm� r"nistrator . . 0 0 0 0 0 0 (n <br /> DOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> )efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> vith 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 />