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<br /> Burnett County Office of Zoning Administrators o 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT
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<br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m :�
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a
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<br /> OWER (please print) /� / CONTRACTOR or SU F. EVOR or AGENT a
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<br /> A DRESS / ADDRESS $
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<br /> ADDRESS ADDRESS
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<br /> PH PHONE
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<br /> PLU BE WELL DRILLER
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<br /> PHONE PHON.... E
<br /> DESCRIPTION 4. Sanitary Facilities: / ° o o °b-1
<br /> 1. Work: No. Bathrooms µ
<br /> 2. New Building Details ""' '•' � 0 j
<br /> New Building ,,,,,,,,,, Type of Constructiory No. Bedrooms .......... rJ:� 9p
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<br /> Addition ...... S/ Z.� Septic Tank Size Gals. . ..... .. y�
<br /> Sanitary '"'' Size .............. ft. x ........ ... ft.
<br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site:
<br /> Moving .......... Area Soil Type .................................... prp r
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<br /> Mobile Home Slope .................................I........ O
<br /> Privy ,,,,.,,.,, 3. Use (describe exact) 1 -family Perc. Rate ................................... P6
<br /> Well .......... home,garage, motel, etc. Dry Well .......... C:
<br /> Subdivision Seepage Trench .......... t
<br /> Camping Unit .......... .................................................... Privy
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<br /> --------- --------------------------------------------Seepage Bed
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<br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc.,should be, sketched in Fig_ A. Include road C7
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- I a
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5.
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<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. : o
<br /> 5. Lot Size: Fig. A. 6. Location: r
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<br /> ................ ft. x .............. ft. — ....... ...................... sq.ft. ................
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<br /> Signature of Owner Agent Date I _
<br /> Remarks .... ................................................................................................................................. i m
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<br /> Inspection Date ... ................................. ,
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<br /> ZoningAministrafor /Cl y
<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 Iie made without approval of the Zoning Administrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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