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Burnett County Office of Zoning Administrator v 0 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3
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<br /> TO-THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as '� m '"
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<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
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT
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<br /> ADDRESS(` jC, ADDRESS = :� V,
<br /> ................`.. ......................................................................... .AD......DRES."'E'S".............................................................................. I
<br /> ADDRESS S
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<br /> PHONE................................................................................ PHON
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<br /> PLUMBER WELL DRILLER
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<br /> DESCRIPTION 4. Sanitary °or
<br /> 1. Work: 2. New Building Details No. Bathrooms
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<br /> New Building ,,, , ,,, Ty Construction: No. Bedrooms .......... n..._a 0 }1J
<br /> Addition ...... ... ,,,,, �e1,J�YTI�,�,,,,,,,,,,,,,,,,,,,,, Septic Tank Size Gals. ..........
<br /> Sanitary .......... Size A.La..... ft. x ...ol. ... ft.
<br /> FillinglGrading .......... Height............. Stories ..............
<br /> 4a. Absorption Field Site:
<br /> Moving Area Soil Type .................................... r
<br /> .......... ............... ... ...............
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<br /> Mobile Home .......... Slope .......................................... .+
<br /> Privy „�.... 3. Use (describe exactly, 1 -family Pere. Rate ...................................
<br /> Well .......... home,garage, motel, etc.) Dry Well .......... :--
<br /> Subdivision
<br /> kb '� Seepage Trench .......
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<br /> Camping Unit
<br /> ....�.. ............................. .X1
<br /> .......... Privy ..........
<br /> .................................................... Seepage Bed
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<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 o-
<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. o'
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<br /> 5. Lot Size: Fig. A. 6. Location: �
<br /> ................ ft. x .............. ft. — ............................... sq. ft. ..............................................................................
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<br /> Signature of Own o p
<br /> or Agent Date �j —
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<br /> Remarks ..ii...... .......l.....W�?.��r m m
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<br /> Inspection Date w T
<br /> Zoning Admini ra or
<br /> NOTE: A preliminary site Inspection must be made and si e approval granted on all structures Involving sanitary facihtwu
<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 lie made without approval of the Zoning Administrator .
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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