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Burnett County Office of Zoning Administrator C - o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . o <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 7 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> CD <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n. :Q V <br /> '• <br /> h l vl 'e 11... ..n i�-r c :\ o <br /> ......�.. ............. . . ..... <br /> OWNER (pl ase � t CONTRACTOR or SURVEYOR or AGENT a _ <br /> IUN-J.. ..!. .�..........�� S � . .. . <br /> r�- <br /> ADDRESS ADDRESS <br /> .......... <br /> ADDRESS ADDRESS � 14'.1 <br /> .................................................................................... <br /> PH05F,!•1 PHONE <br /> PLUMBER WELL DRILLER <br /> -'D'' ................................................................*"*"............... _. <br /> ..... . . . . : <br /> ADDRESS ADDRESS CD <br /> CD f s "S <br /> ....................... ............................................. <br /> PHONE PHONE Z :3r <br /> DESCRIPTION 4. Sanitary Facilities: 1 ° o ° <br /> No. Bathrooms �i <br /> 1. Work: 2. New Building Details •••••••••• ( o '\ <br /> New Building ... ...... Type of Constructiob;1 ) No. Bedrooms G \ :i :x <br /> Addition ...•.•i-- �j•.}C...T•�••f•�r••• , , • Septic Tank Size Gals. .^ <br /> Sanitary Size .............. ft. x ........... ft. •��••v <br /> Filling Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type .................................... ` r <br /> .......... Area ......................................... o <br /> GradingSlope .......................................... <br /> Perc. Rate .. .. . <br /> Mobile Home .......... 3. Use (describe exactly family C� <br /> Privy •••.••••.. home,garage, motel, etc.) Dry Well .......... �{� :`✓ <br /> Well Seepage Trench .......... <br /> Subdivision Privy <br /> .................................................... <br /> Seepage Bed <br /> -------------------------------------------------- ------- Gy : <br /> :�-- <br /> Location of proposed structures and existing structures, well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road <br /> is <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTINGl H <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o' <br /> —————————————————————————————————————————————————————————————————————— �f/I <br /> 5. Lot Size: Fig. A. •, 1 <br /> ft. x .............. ft. — ���:r.�.5.... sq.ft........... ; <br /> CD <br /> 0 <br /> N o <br /> o <br /> ra <br /> N <br /> f•F <br /> V : 0 <br /> O <br /> : 1 <br /> o <br /> �^ <br /> CD <br /> rt <br /> 00 <br /> 0 6q rs Z <br /> N Q Q•G —�' Q rr <br /> H' D <br /> Z p p' <br /> o 7 <br /> fA <br /> N <br /> O <br /> O rr <br /> 77 <br /> 8 �— - c <br /> ....... ........ ..................... ...................... . ...... ...........................J•••...� o <br /> Signature of Owner or Agent Date : = <br /> "n X rr <br /> ......Remarks . :......%...:.............:. m r <br /> rr <br /> Inspection Date ..1 :..r................. !/.: .. ..:........ ................................................ c o cn o o rr <br /> ZoningAdministrator o 0 C o c! <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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECFED BY THIS OFFICE AND APPROVED. �! <br />