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Burnett County Office of Zoning Administrator �' c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> v y , ' <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,8 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 `a <br /> regulations of the State of Wisconsin. / a <br /> r............ .�. ' .e .............. ............................................................................................ <br /> OWNER (plane print) r CONTRACTOR or SURVEYOR or AGENT y <br /> .11.... .r....�r .!Q /1/l..�l.r ............................................................................................ d ti <br /> ADDRESS ADDRESS + <br /> SI.....P. .! )f ADDRESS <br /> ......... ............................................................................................ <br /> ADDRESS ADDRESS <br /> ............. . <br /> tCGF�.�...........�.7.. ..-.��.1�. 3 ........................................................................................... <br /> PHONE PHONE :(yQ <br /> ........................................................................................... ............................................................................................ <br /> PLUMBER WELL DRILLER <br /> ............. v n <br /> ADDRESS ADDRESS 'm 0 <br /> O <br /> PHONE PHONE 2 � r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms . <br /> 2. New Building Details --'-'- ••• p <br /> Now Building ,,,,,,,,,, Type of-Coos JJ{{U�C�tiOn: No. Bedrooms .......... <br /> Addition /1(11EE ,,,,y Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ........0L/. ft. x ...a.»{.2..� .......... i <br /> FIIIIngrGrading Height.../o..:z... Stories ..../!.efR... 4a. Absorption Field Site: i <br /> Moving .. Soil Type .................................... <br /> Mobile Home .......... Slope .......................................... ^ <br /> Priv Perc. Rate ................................... <br /> d <br /> Privy .......... 3. Use (describe exactly -family � <br /> Well .......... home„grayps,rnotgl, etc.) Dry Well .......... <br /> Subdivision ..,,,,,.,, L 1155/ /T/ Seepage Trench .......... o i '•- <br /> ...................................... <br /> Camping Unit ,__-,_.... Privy .......... <br /> .................................................... Seepage Bed <br /> ..........� <br /> -- ------------------------ ------------------- 1 y <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at `- <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ''- <br /> 0 <br /> --------------------------------------------------------------------- <br /> 5. Lot�7gize: Fig. A. 6. Locatio t - <br /> .L.7...Qt... . .sft. - .... ............ sq.ft. .........,/.Fh. O. .... l.T..4. ......"..... <br /> J 0 <br /> N o. <br /> o O <br /> i <br /> 5 v <br /> O <br /> 1I o <br /> / m <br /> Z <br /> 0 <br /> m <br /> m <br /> 31 V1 v Nr D m <br /> C <br /> o �`c < D = o `-� `-_ rn <br /> m. �a < - nm nn7g <br /> o < m C m > > 3 <br /> $w p Z m <br /> o d+o 'Z a -i <br /> 55S 0 <br /> / $ C <br /> .... .......................... .. .f. . . ..... . ......... . In <br /> ......7.......!.. ..... 7 f� : In <br /> Signature of Owner or Agen to o <br /> Ti m <br /> Remarks � n ' <br /> _ N <br /> Inspection Date ....................................... .. ....... <br /> Admin <br /> NZoning S. u <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />