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Burnett County Office of Zoning Administrator "g4
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3•
<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 0' ;W
<br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he
<br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws End 3
<br /> regulations of the State of Wiscoonsin.
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<br /> OWNER (please nt) CONTRACTOR or SURVEYOR or AGENT
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<br /> ADDRESS ADDRESS
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<br /> ADDRESS ADDRESS
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<br /> PHONE PHONE , {
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<br /> PLUMBER WELL DRILLER
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<br /> AOORESS ADDRESS
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<br /> PHONE PHONE Z r-
<br /> DESCRIPTION 4. Sanitary Facilities: ° o
<br /> No. Bathrooms
<br /> 1. Work: 2. New Building Details .. ""' c
<br /> Ne. Building No. Bedrooms
<br /> TYPe ppff--CC��ry�tru�tio .... ..... R
<br /> Addition ,�, ,,,,„ ,,t.-J .�. :t ,,,,,,,,,,,,,,,,,, Septic Tank Size Gals. .... .....
<br /> Sanitary Size ..r�.5�.... ft. x .../.�.�..,... ft. .... ..... i
<br /> "........ v< 4a. Absorption Field ite: '
<br /> Filling/Grading .,,,,,,,,, Height.../.....�. Stories .....�.......
<br /> Moving .......... Area Soil Type ....... ...................... ..... i o
<br /> Slope .........
<br /> Mobile Home ”"""""""""' "'
<br /> Privy Perc. Rat ............................. .....
<br /> .......... 3. Use (describe exactly, -family
<br /> Well .......... home,garage,motel, et ) Dry We .... ..... m
<br /> Subdivision .......... ' y Seep e Trench .... ..... o �-
<br /> Camping Unit .......... .. .Yl.(?�Q...-..T..l.. .:'1:IG(fi11t�Pr' .... ..... i
<br /> ,J adage Bed .... .....
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<br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig A. c
<br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at ?j
<br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersects n.
<br /> CLEARLY LABEL EXISTING 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 ner or Agenn Date o
<br /> Remarks .... ......... . �err�I ..:................... ..... ...... .........
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<br /> Inspection Date .......................................
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<br /> Zoning Admini ator. rznYl 880)NOTE: A preliminary site inspection must be made and site ap oval 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 appli ation 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 pecifications shall not be
<br /> made without approval of the Zoning Administrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APF ROVED.
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