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Burnett County Office of Zoning Administrator d - --1 z <br /> ° <br /> — LAND USE — BUILDING PERMIT 3'' ; ° <br /> APPLICATION FOR SANITARY � <br /> -Tb 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 c <br /> Ordinance, Sanitation Code,and with <br /> 'all <br /> loother applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a (� <br /> . .....�9..... r�yr �.� .............V.�?..!!.h.s.Ct� ........ ....... .Q..`�.h.. .......... .......N.I e.,�s P. ............... H o <br /> OWN/E�R (pleasePrl7t) CO< ACTOS}�RVEYOR or AGENT <br /> l!..S[..!1...�1..N.� .......... /.s................................. ...........F...^,r d P r^r c a i� E <br /> ADDRESS <br /> ADDRESS <br /> m <br /> A <br /> .................. ............................................................................................ <br /> ADDRESS <br /> ADDRESS 't <br /> ................................... ..................................................... .......... Q > 1 <br /> PH . . .......................................................................... ?. <br /> r PHONE \ p.i <br /> ......................................... ..............,...................................,...................................... <br /> PLA <br /> UMBER WELL DRILLER <br /> :\ <br /> ADDRESS .......................................................................................... O <br /> ADDRESS ;00 <br /> o �--} <br /> N < I <br /> ....... -• <br /> PHONE PHONE....................................... ....................................... •° .: •a <br /> Z <br /> r s� <br /> DESCRIPTION 4. SanitaryFacilities: o o ;� <br /> 1. Work: No. Bathrooms o <br /> 2. New Building Details .......... (r <br /> New Building .. ....... Type of Construction: No. Bedrooms i r° j <br /> Addition s hn, e....... Septic Tank Size Gals. :(N <br /> i <br /> Sanitary (c.'••„ fn. 0 . <br /> ..�� Size .�lr.... ft. x ,E...�... ft. a.�..... -gyp <br /> Filling .......... Height........... Stori s ............... 4a. Absorption Field Site: <br /> �OUc <br /> Moving .......... Area .....7.,z... ���� Soil Type ................................ .. <br /> Grading Pup�""`ce.tPq(/... .. yT�y Slope .......................................... �. UI <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... EC E <br /> Privy home,garage mote etc.) Dry Well <br /> Well ........ . .................................................... Seepage Trench .......... <br /> Subdivision Privy 16 <br /> E . <br /> __________ _____________________ <br /> .......... .................................................... <br /> Seepage Bed <br /> Cn <br /> _ocation of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road e <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 CIOaction, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING LI Z <br /> iTRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. U ffi.o <br /> ---------------------------------------------------------------------- ? 0 <br /> i. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................ .. : e <br /> � n <br /> Oa i 0' <br /> 0 <br /> 7 Z <br /> O <br /> 1 <br /> s <br /> 2i <br /> • ° 37 <br /> d <br /> tD <br /> rnr � z <br /> c m m <br /> iD. N a CL< <br /> cn < - a <br /> < O 't7 <br /> Z 0 5: - « g m <br /> m <br /> .. <br /> ' aSo � <br /> �. m <br /> .30(- <br /> ................................. � . pignature Date °............................. <br /> temarks ................. -n x pL: m <br /> ...................................................................................................................................................................................... <br /> ................................................................... : <br /> nspection Date ....................................... ¢°!le��.. ...�..A.d*' . . ......... ... ' 0 0 0 <br /> m <br /> " ' 000' bm <br /> Zoning Admin strator ��� i i o 0 0 o U1 <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> -fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> is application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith 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 />