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Burnett County Office of Zoning Administrator d 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 o \
<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 at
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT
<br /> Luck, WI 54853 � S Sas'-3i6d — a
<br /> ADDRESS ................................----..........cr... . ......r...... . .......................................................................................... m .\ C7
<br /> ADDRESS
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<br /> ADDRESS ADDRESS
<br /> ............7 j 5-472-24.24. i
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<br /> PHONE . ..........................................................................................
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<br /> PHONE CD Daniels .............................................................
<br /> WELL DRILLER
<br /> PLUMBER \\
<br /> ..... . ....Pq: .Jw.............Siren....W1.....54872.................
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<br /> ADDRESS ADDRESS
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<br /> ............7.1.5A.6.3-233.3................................................... ............................................................................................
<br /> PHONE Z o'
<br /> PHONE '
<br /> DESCRIPTION 4. Sanitary Facilities: ° o °
<br /> 1. Work: No. Bathrooms 1......
<br /> 2. New Building Details ••• \1 0
<br /> New Building No. Bedrooms 'o '
<br /> x... Type of Construction: 2......
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<br /> Addition ,,, , ,••j1,pg„,�}pfpg,,,,,,,,,,•,,,,••,,,,,,. Septic Tank Size Gals. 7.50....
<br /> Sanitary .....X... Size ......24... ft. x ...2.4J...whLoft: ..........
<br /> Fillinglcrading ,,.,,,,,•, Height............. Stories-...1. ........ 4a. IS Field Site:
<br /> Moving .......... Area .............6.004 Soil Type ..............................
<br /> Mobile Home Slope .................................. . .
<br /> .......... :E o
<br /> PrivyPerc. Rate .......................... ......
<br /> .......... 3. Use (describe exactly, 1 -family
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<br /> Well Dry Well .......... '.� :r :.
<br /> home,garage, motel, etc.) F
<br /> Subdivision ••••., single family home Seepage Trench ......... ;z
<br /> Camping Unit .......... Privy .......... ..•:
<br /> .................................................... Seepage Bed
<br /> ------- ..X...... cr
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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 °C' c Z
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- � ;� a
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <.
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<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. S ;d).
<br /> 5. Lot Size: Fig. A. 6. Location: o d'
<br /> ....�.�.�. ft. x ../0 .... ft. — ....... .r..V 8 sq.ft. ...............................................................................
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<br /> Signature of Owner or Agent Date
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<br /> Remarks .. ............................................................................................................................................. .� m
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<br /> mInspection Date ....................................... m.................
<br /> Zoning Ad.mi.n.. 88 $ 8
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<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 riot 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 wl hout approval of the Zoning Administrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED B THIS OFFICE AND APPROVED.
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