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Burnett County Office of Zoning Administratord o Z
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<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 v
<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,
<br /> Sanitation Code, and with all other
<br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 C ! �j
<br /> K.l.... ...v].......�..�.. .�y�Y.!•./......... .. .... ............................................................ " m O
<br /> OWNER Sse ring _ ONTRACTOR or$URVE R or AGENT C pp
<br /> ADDRES r ADDRESS l ."•••.•.
<br /> . ............... ... ........................................................................................
<br /> ADDRESS :O
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<br /> PHONE PHONE
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<br /> PLUM WELL DRILLER ��p"
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<br /> ADDRESS ... ...... . ...............................................................................
<br /> ADDRESS
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<br /> P.!'.E.....................}r.." 0.... '.fes...'........................ ..... . . . 5 11 R
<br /> FlPHON.E....................................... .......................................
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<br /> DESCRIPTION 4. SanitaryFacilities: ° o °
<br /> 1. Work: 2. New Building Details No. Bathrooms ...I...... i4\ v
<br /> New Building ,,,,,,,,,, Type of Construction: No. Bedrooms .......... :O
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<br /> Addition .......... Height............. Stories ........... ... ,$'/!/�,.Tank Size Gals.
<br /> Sanitary Size .............. ft. x .............. ft. i
<br /> Filling/Grading 4a. Ab50r4t On Field Site: �\
<br /> Moving .......... Area ........................................... Soil Type ....................................
<br /> Mobile Home ,,,,,,,,,, Slope ...... J ,o,
<br /> .................................... i
<br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... E
<br /> Well .......... home,garage, motel, etc.) Dry Well ..........
<br /> Subdivision „ ,,,,,,,. Seepage Trench
<br /> Camping Unit__________________________________........ Seep .......... ,
<br /> ....................................................
<br /> Seepage 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 `s
<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 n
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. --- ---- -- --- ---- --- I A` N
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<br /> 5. Lot Size: ...............................................................
<br /> . .......... . ...
<br /> Fig. A. 6. Location:
<br /> .... ft. x .......... ... ft. —
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<br /> Signt io
<br /> ner or Agent Date �/V ° C
<br /> Remarks . ,elr,` G'(l7i`'Q� 2u`u'” T x
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<br /> .............. ..2I�Otey- cP L�.i...aZsi�cLU" ... �.. �i- � •�
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<br /> ..�.�..`.. �—
<br /> Inspection Date m
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<br /> Zoning Admin' trator i�� g g g g g g N
<br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involvi � sanitary fa flit ies
<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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