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Burnett County Office of Zoning Administrator - 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: -ihe 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 Use n c v <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> 3. <br /> . .tJ.. .�Y.. ........... o.. .. ..� ............... ........... <br /> O NER (Please pri tl CONTRALTO SURVEYOR or AGENT <br /> •• M O <br /> r%............ x..... <br /> iv.9... ........................... . . . . . ................................................................................. <br /> ADDRESS <br /> ADDRESS 1 <br /> ......................................... <br /> ADDRESS ADDRESS <br /> ................................................................... <br /> PHONE PHONE ............. <br /> PLUMBER WELL DRILLER <br /> ADDRESS . .......................................................................................... <br /> ADDRESS <br /> o <br /> PHONEPHONE....................................... ....................................... j ., <br /> DESCRIPTION 4. SanitaryFacilities: ° o 0 <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •��•�•••�• � ; <br /> New Building .X.... T No. Bedrooms '� <br /> ype of or),str c 'ory ••••••• <br /> Addition ••• , . ..• •r!�, .,rlJ••,•G Septic Tank Size Gals. .... ..... y <br /> .... ..... . . . n •< <br /> Sanitary .......... Size ...�. .. ft. x .a. ... ft. .......... <br /> Filling/Grading .......... Height............. Stories ..1 4a. Absorption Field Site: '• i <br /> Moving .......... Area ........................................... Soil Type .................................... <br /> Mobile Home Slope .......................................... 3 o <br /> Privy Pere. Rate ................................. . F <br /> ... ...... 3. Use (describe exactly, 1 -family <br /> Well ......•... home,garage, motel, etc.) Dry Well .......... M <br /> Subdivision ,,,,,,,,,, A Seepage Trench <br /> .....- ...................... <br /> ........ . <br /> 'tl <br /> Camping Unit .......... . . .. ..... Privy .......... <br /> .................................................... <br /> ___________________________________________ Seepage Bed .......... <br /> r C <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road ti W <br /> 0 <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- L ia <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTINGtj <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 0 <br /> 5. Lqt Size: ------- --- C <br /> { Fig. A. 6. Locati ? <br /> ..... v..... ft. x -Z�041... ft. . ............................... sq.ft. ......... ..Q.3.?Q2..... ............................ p <br /> o >' <br /> O_ <br /> 7)00 <br /> [Z ! E <br /> Z <br /> o <br /> _ <br /> 1 <br /> U <br /> �on�er 4—�e /est C ; °° <br /> ffl d F <br /> -5 on a m < ao m m <br /> Z O N D n <br /> O fA= o m 3 <br /> o <br /> r0 rn <br /> Signature of Owner or Agent Date ° C <br /> X . <br /> Remarksxt :. .Q..9. .................................................................................................................. .T, m <br /> „ O <br /> ........................................................................................................................................................................................ <br /> ............................................................................................................... .. ............... ............... ; <br /> II <br /> �� ...... <br /> Inspection Date ....................................... ....... ............. .................................. <br /> Zonin inistrator . . $ $ $ $ <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitie. <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 />