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bop_�C>•C�'1 . <br /> Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < m <br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use C <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> 7 ...`�..............................................................t-PO�IJ .... . .....`. ..'f-=... �....�.......� .......................... <br /> a <br /> OWNER (please pant <br /> fyJ) CONTRACTOR or SURVEYOR or AGENT a <br /> !�1 S 6t1 C. <br /> ADDRESS............................ .................. . .......................... .ADDRESS............................................................................ m <br /> RA <br /> ADDRESS ADDRESS <br /> PHONE................................................................................ .PHONE..... <br /> T... <br /> J..f�!2.. ..?.. ........................................ .......... t <br /> . ............. ...... . <br /> PLUMBER � WELL DRILLER <br /> ............................................... o � <br /> ADDRESS ADDRESS <br /> 1 <br /> PHONE PHONE Z N ' <br /> DESCRIPTION 4. Sanitary Facilities: ' o °r Q <br /> 1. Work: No. Bathrooms ..... .... .� <br /> 2. New Building Details o <br /> New Building ,,,, Type of Construction: No. Bedrooms ...e7.... :�� 1 <br /> Addition lQHY� Septic Tank Size Gals. <br /> O <br /> Sanitary Size .......... ft. x .... .Zr. ft. ✓'•'�•'�r� <br /> Pilling/Grading .......... Height....$...... Stories ............. 4a. Absorption Field Site: <br /> Moving .......... Area .......g.3 ....................... Soil Type ...........�. N <br /> r <br /> 0 <br /> Mobile Home Slope ............... .- -+ <br /> Privy ...I...... 3. Use (describe exactly, 1 -family Perc. Rate .............. .................... <br /> Well ... ., ,., home,garage, motel, etc.) Dry Well .......... <br /> Seepage Trench .......... <br /> ..............................................subdivision <br /> t <br /> Camping Unit .......... Privy .......... <br /> Seepage Bed /F' <br /> ________________________________ <br /> Location of proposed structures and existing structures, well, sewage systems, roads etc., should be sketched in Fig A. Include road 1 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- i� i 1 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r3 � < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS C��T _-- — _— : o <br /> __ — ------ ------------------ F <br /> 5 Lot Size: Fig A. 6. Location: y— <br /> .....l�d... ft. x ..�BO.Q. ft. �.. O©Q s ft. ................................ <br /> IN \ o. <br /> o C• <br /> O <br /> _ <br /> o <br /> m <br /> n; o <br /> a <br /> io = <br /> 01 r- 'a <br /> on a Z m = B. F <br /> m N dC: m 4 m <br /> ry : <br /> Z 03 D a <br /> O = <br /> 6s - <br /> . ........... .. .... ........ ...................................... : o C <br /> m <br /> m <br /> Signature of Owner or Agent Date — <br /> X <br /> Remarks ......................................................................................................................................................................... „T m0 <br /> m : <br /> EA <br /> n <br /> .. ............................ ...................... <br /> iiij <br /> Inspection Date ....................................... � �'.. � i I <br /> / .. .. ...... .. .... ...-GCGxG-.��.a..kt�.................. l�'i o u o u o u m <br /> Zoning AdminiSErator -<J 8 8 8 S 8 8 y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitie's <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. <br />