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<br /> Burnett County Office of Zoning Administrator 0 0
<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 located as •� :�
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use
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<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin.
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT
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<br /> ADDRESS ADDRESS
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<br /> ADD ESS ADDRESS
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<br /> PHONE
<br /> PHONE
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<br /> ..DR. . ..LLER. .........................................................
<br /> PLUMBER WELI
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<br /> DESCRIPTION 4. Sanitary Facilities: ° o °
<br /> 1. Work: 2. New Building Details No. Bathrooms .......... C• o
<br /> New Building �( Type of Construction: No. Bedrooms .......... /..
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<br /> Addition ,,,,,,,,,, W O FA'.4M IF Septic Tank Size Gals. ..........
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<br /> Sanitary .......... Size ...;�z.... ft. x ...�.6...... ft. .......... .< i
<br /> Fj 4a. Absorption Field Site: A
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<br /> Filling/Grading ,,,,,,,,,, Height LL.......r. Storie/s�......�....... Type
<br /> Moving .......... Area ...�.�.�.......S.HW ..�....... Soil T e .................................... `CyS`• V
<br /> Mobile Home Slope .......................................... i ^
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<br /> Privy y, y Ford. Rate ................................... 9;, :.�
<br /> .......... 3. Use (describe exact) 1 -Tamil �
<br /> Dry Well '
<br /> Well ,......... home,garage, motel, etc.) : P
<br /> Subdivision 5N E� S7a eA 1 QL p6, Seepage Trench .......... i
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<br /> Camping Unit .......... Q.! ...�.. .!�!�..>R N.r.............. Privy .......... C
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<br /> ,Q, SeeP a e 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
<br /> section, show the. intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ra
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<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. :v p'
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<br /> 5. Lot Size: 72, O� Fig. A. 6. Location: LO l- /�z NO/ZTN ,�6Fsv�ow E
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<br /> Remarks ..�`.`....!. ..E... ....................................l.!r ......A...l`.'G.4 Y.4.�...5!iC(!C(:ff.G... ..... LC4.......... x m
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<br /> Inspection Date ....................................... . . ...................... . u,Zoning Administrator g o 0 0 0 0 0
<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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