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3utnett Cbunty _ Office of Zoning Adm vfinis or j= -Vd o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> -O THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <br /> W <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseCDc <br /> )rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3. o. :V <br /> °- O <br /> T � �'CE UaCTa�c K �sr............................................................. H �, <br /> . ............................... . . <br /> )WNER (please print) CONTRACTOR or SURVEYOR or AGENT n v CD <br /> s!�...................................................................................... <br /> kDDRESS ADDRESS °« <br /> ......................................................................... ........................................................................... <br /> kDDRESS ADDRESS <br /> n. ......3..L. -....` .. .%. .................................... ............................................................................................ <br /> 'HONE PHONE <br /> .................................................. WELL. . . . ....R. IL''L'' ...LER..................................................................... :°C1 <br /> 'LUMBER D � • <br /> ......................................................................... ........................................................................... p <br /> ADDRESS ADDRESS CD o <br /> c < <br /> z o + <br /> 'HONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> Work: 2. New Building Details No. Bathrooms n.�... o <br /> New Building No. Bedrooms <br /> .......... Type of Construction: •••••••••• _0 � <br /> (�!/oU� Septic Tank Size Gals. .......... <br /> Addition ..... FRA.M.� <br /> Sanitary .......... Size ..�.'j...... ft. x ......jq.. ft. <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area .... U..+ .....$.. ...r.r........ Soil Type .................................... .Q <br /> Grading Slope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> l <br /> Privy .......... home,garage, motel, etq.) Dry Well <br /> Well d L/�!�rJB Seepage Trench <br /> �. ....Cc'. ...4....c...... <br /> Subdivision F.C!.. G.J.��..z......f�.r.4r. .t.. Privy 0 <br /> Seepage Bed .......... <br /> ------------------------------------------ ----------------------- <br /> -ocation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road <br /> atback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- N _Q <br /> ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING < <br /> N' <br /> TRUCTURES AND PROPOSED STRUCTURES-AND ADDITIONS. p' <br /> ---------- ----------------------- ---- ----------- <br /> i. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> co <br /> n <br /> N O <br /> O 7 <br /> O <br /> 7 <br /> N <br /> r-F <br /> D'3 <br /> s <br /> -n <br /> CD <br /> z <br /> 0 <br /> O <br /> n <br /> ID <br /> cn vnmz <br /> C�7 6 7 C• cp C CD <br /> d <br /> z oo � m <br /> o � <br /> :0, <br /> p <br /> ..... '................ ....6.. �............ .�...... - <br /> o C <br /> � <br /> iigna/Zre of Owner or Agent Date X <br /> m <br /> iemarks ................................................................................................................ ........................................................ CD <br /> M <br /> co <br /> to <br /> ........................................................................................................ ............................. .... ......................................... s. <br /> M <br /> nspectionDate ....................................... � .......:.... ....fie .........� J.................. o 6 66 o rn <br /> Zonin Adm nisi trator o 0 0 o <br /> OTE: A preliminary site inspection must he made and site approval granted on all structures involving sanitary facilities <br /> More construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> is application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> g 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 />