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Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as + .LJ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m 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 /> n� <br /> OWNER (pleaseprint/ ) CONTRACTOR or SURVEYOR or AGENT Q <br /> .... .................. .................. <br /> ADDRESS ADDRESS <br /> ..............�n." wL -^..... ..fir f. rj..�.................... <br /> ADDRESS ADDRESS <br /> ................... ..�..-...c'e..7............................... ............................................................................................ <br /> PHONE PHONE <br /> ................................................................ ....... <br /> PLUMBER WELL DRILLER <br /> C7 <br /> ........................................................................................... _. <br /> ADDRESS ADDRESS CD L) <br /> n O <br /> r* < <br /> ............ o' <br /> PHONE PHONE z N � <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building Type of Construction: No. Bedrooms ' <br /> Septic Tank Size Gals. ' <br /> Addition ..�.. ......G.�^...��. . . p .......... � <br /> Sanitary <br /> .......... <br /> Size ft. x ft. : <br /> Filling ••.......• Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Soil Type .................................... <br /> g .......... Area ................................... o <br /> Grading Slope .......................................... <br /> 50 <br /> Mobile Home .......... 3. Use (descri e exactly, 1 family Perc. Rate ................................... r� <br /> Privy ......•••• home adage motel, etc.) Dry Well <br /> Well Seepage Trench .......... ' <br /> .......... <br /> Subdivision vy .......... N <br /> .......... <br /> Seepage Bed <br /> ---------------------------------------- -------------------------- c <br /> Cn <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road r <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. N <br /> P o' <br /> --------------------------------------- ---------- lC 5. Lot Size: Fig. A. 6. Location: <br /> x — ..................... sq. ft. .... .&..L.!^... .....�..... ,..,.�. ........... ft. ., <br /> l N <br /> NCD <br /> T 0 <br /> O o <br /> 0 <br /> N <br /> o <br /> 7 <br /> m <br /> �o (n r- (n co z <br /> CD c CD C ID <br /> oy. CD � m <br /> 0 <br /> M <br /> :Z <br /> Signatu of wner or Agent f�i Date X <br /> `` ....................................................................................... „ m <br /> Remarks .................................................................................. <br /> m <br /> CD <br /> eu., ...; `...��a..9.� ............................................................................................................................... <br /> (6 m <br /> Inspection Date ....................................... / 4P.. .... /�� J : <br /> �*.................... 000000m <br /> Zoning Administrator «J o 0 0 0 0 o fA <br /> DOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> iefore 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 Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />