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Burnett County Office of Zoning Administrator o
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3
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<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 m c
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin, 3 d
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<br /> OWNER
<br /> pD(please print) ,.J_ CONTRACTOR or S RVEYOR or AGENT 3. _.. :-
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<br /> ADDRESS ADDRESS :O
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<br /> ADDRESS ADDRESS ?f 1 i p it E i-7
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<br /> PNE PHONE
<br /> 1 LR\ CSC
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<br /> PLUMBER WELL DRILLER ifhj i
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<br /> ADDRESS
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<br /> PHONE PHONE
<br /> DESCRIPTIONr-
<br /> 4. Sanitary Facilities: � ° o °
<br /> 1. Work: No. Bathrooms
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<br /> 2. New Building Details
<br /> New Building ,,,,h, TypeA Construction: No. Bedrooms .... .... ;_
<br /> Addition ,,,,,,, !!�,!Z.MM.Y................•,•.. Septic Tank Size Gals. ........ `
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<br /> Sanitary .../'.... Size ..d..�.... ft. x ..Y..d.... ft. 7.5....
<br /> Filling)Grading ,..,,,,,,, Height............. Stories ............... 4a. Absorption Field Site:
<br /> Moving .......... Area A.J.y.}.y......��..'.Q..^.V.�.'•� Soil Type .................................... :So
<br /> Mobile Home .......... Slope .......................................... ...
<br /> Privy .,.,..,,,. 3. Use (describe exact) 1 -famil Pero. Rate ...................................
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<br /> Well .......... home,garage, motel, etc. Dry Well .......... � t�
<br /> Su btlivision .......... $eepdge Trench .......... UJ
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<br /> Camping Unit Privy
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<br /> ______________________________ Seepage Bed
<br /> _____/____y_ Cj
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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 1 c
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter ;0 a
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING UU
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS.
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<br /> S. Lot Size: Fig. A. 6. Location:
<br /> .(.O.L...... ft. x ..�..44.b. ft. . ..................... sq. ft. ...............................................................................
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<br /> Signature of Ow r or Agent Date C
<br /> Remarks .. .... .. .. ....................................................................................................................................................... T m
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<br /> Inspection Date .�7'....`........ .�......... .. ...... ....V7`i"•!�.`.":/.�..(�. ............................. o
<br /> Zoning dmiPC nistratori g o 0 0 0
<br /> NOTE: A preliminary site inspection must be made a d site approval granted on all structures Involving sanitary facilitlec
<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 Adrn inistrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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