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Burnett County Office of Zoning Administrator o 0 <br /> .APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o ,N�" <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < ; :� <br /> >hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c ; <br /> Jrdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> �* p <br /> fD <br /> DWNER (please print) CONTRACTOR or�U� VEYO or A T a <br /> co <br /> .......................................................................................... .� f ... si. ................................... <br /> 4DDRESS ADDRESS <br /> CD <br /> .......................................................................................... y...... .. .. r...1� .......r�.yAI <br /> .............................. ► <br /> 4DDRESS A REDD S �Q <br /> .......................................................................................... P..H..ONE.. ... .................................................................................. <br /> 'HONE NZ3 <br /> ........................................................ <br /> 'LUMBER W ELL RI LLER D <br /> v <br /> .......... <br /> ADCD <br /> ......D.RES......S.................................................................... <br /> 4DDRESS CD <br /> 0 o <br /> ............................................................................. ............................................................................... O r+ <br /> PHONE PHONE <br /> Z ti r <br /> DESCRIPTION 4. SanitaryFacilities' ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ......•••• o <br /> New Building Type of Construction: No. Bedrooms ........ 0 <br /> Addition <br /> Septic Tank Size Gals. <br /> .......... .................................................... . . . <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> SoilType .................................... r <br /> Moving .......... Area ........................................... <br /> Grading Slope .......................................... : o 0 <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage,motel,etc.) Dry Well .......... <br /> Well Seepage Trench .......... `• <br /> .................................................... <br /> Subdivision Privy <br /> .......... ......•••• <br /> .................................................... Seepage Bed <br /> ------ ----------------------------------------------------------- cn :\ <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 /> a <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. H <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x ft. sq.ft. Cn <br /> G!/ N oLo <br /> N <br /> O <br /> 70 <br /> z <br /> o <br /> n <br /> La <br /> CD <br /> Coz <br /> C <. C,; CCD <br /> 0 a-'0 LTI m <br /> H: G cn m <br /> z 0o fD ' m <br /> ° <br /> L <br /> Cb <br /> ........................... o <br /> Signature of Owner or Agent Date �* <br /> X <br /> Remarks - :� '• '• M <br /> CD <br /> to <br /> ..................................................................................................... .............. ......:.................................. ?C N 11 <br /> Inspection Date ....................................... . ........ ... <br /> o 0 0 0 o cn m <br /> (O/ ........1c:%............. 000000m <br /> Zoning Administrator . . c 0 0 0 0 0 0 cn <br /> TOTE: 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 /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> /ith 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 />