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Burnett County Office of Zoning Administrator o z
<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 '� ~ 0
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Usec ll��1
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3i'
<br /> WA cfER GC As1-/r9/✓ �CLl.... ........ .... ... .... . .... v � " -
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<br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT m � m
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<br /> ADD ESS ADDRESS
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<br /> PLUMBER
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<br /> ADDRESS .ADD'' 'D...R..ES.................................................................................
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<br /> PHONEPHON..E......................................... o.......................................
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<br /> DESCRIPTION
<br /> 4. Sanitary Facilities: q o
<br /> 1. Work: No. Bathrooms
<br /> 2. New Building Details ���••���� :
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<br /> New BuildingNo. Bedroom ..........
<br /> T e of Co sty ction:
<br /> Addition .,J�... ,• •(� C'A,/1/G Septic Tank S' s. .......... C�
<br /> Sanitary ..... .... Size ...9..y.... ft. x .....,Zr.R... ft.
<br /> Filling/Grading ..., ..... Height.......... Stories ............... 4a. Absorptio F Id 'te• i
<br /> Moving .......... Area Soil Type . ..
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<br /> Mobile Home ........ . Slope ......... ........ .................. . -+
<br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ........... ......................
<br /> Well home arage, motel, etc.) Dry Well C, C .
<br /> SubdivisionK•,.....,.,.••.••,,......,•••. Seepage Trench
<br /> Camping Unit ,,,,,,,,,, Privy ,,,,,,.,,, �.
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<br /> Seepage Bed ..........
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<br /> Location of proposed strictures and existing structures, well, sewage systems, roads, etc-,should be Sketched in ER 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- � a
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING Q 5
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS.
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<br /> 5. Lot Sizes Fig. A. 6. Location:
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<br /> ...1. ,5.../. ft. x ....� .t2.. ft. . ............................... sq.ft. .............................................................................., 4
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<br /> Signatof 0 r-' Agent Date/ O p
<br /> ure
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<br /> Remarks ......................................................................................................................................................................... m M
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<br /> Inspection Date ....................................... .. :'J u U u o m
<br /> Zoning A inistrator $ $ $ $ y
<br /> NOTE: A preliminary site inspection must be made a d site approval granted on all structures Involving sanitary facil ii a
<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 marle without approval of the Zoning Adm inistratr r.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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