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<br /> Burnett County Office of Zoning Administrator e -- 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 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 7 ;
<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 /> ......D'4RRELL.....A:......./I 1�ERLE y N o
<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT - G
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<br /> ADDRESS ADDRESS » n
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<br /> ADDRESS YADDRES
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<br /> PHO.�{E PHONE
<br /> PLUMBE WELL DRILLER
<br /> ADDR S ADDRESS
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<br /> PHONE PHONE Z
<br /> DESCRIPTION 4. Sanitary Facilities: / ° o °
<br /> 1. Work: No. Bathrooms
<br /> 2. New Building Details
<br /> New Building
<br /> ,,,,x,,, Type,4f Construction: No. Bedrooms ..sad..'.... :`C
<br /> Addition ...,... ,. ....... RR. M.E.................. Septic Tank Size Gals. -.�
<br /> Sanitary
<br /> .......... v% : i A
<br /> ... ... Size .t....a,.. ft. x ie .... f.. 4a. Absorption Field Site:
<br /> Filling/Grading Height............. Stories ............ ..
<br /> Moving .......... Area .. Soil Type .................................... I •o �C
<br /> Mobile Home .......... Slope .......................................... »
<br /> Privy 3. Use (describe exactly, 1 -family
<br /> Perc. Rate ................................... ?
<br /> .K .
<br /> Well ,,, ,,, home,garage, motel, etc.) Dry Well ..........
<br /> Subdivision .......... ,.� f41VA.•)/•.f.�C.l.�,�,... ,.,. Seepage Trench .......... ,
<br /> Camping Unit ,,,,,,,,,, etO�X ' Privy ...... ...
<br /> .............. �.....r7./. I�a. .......... ^n
<br /> ' Seepage Bed ...X....
<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- N a
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING p [ =
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS.
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<br /> 5. Lot Size: Fig. A. 6. Location: .� (�•)
<br /> ft. x .lmli�U ft. — ............................... sq.ft. ............................................................................... ^ i
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<br /> Signature of Owner or Agent // ; �V' Y , x
<br /> Remarks ...............................-................................................................................................................................................ mr m
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<br /> Inspection Date ....................................... .... ...�';1�•' �---- di C 8 0 •'o a rt1
<br /> Z Ing Administrator 8 8 8 8 8 8 vmi
<br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities
<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 be 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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