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Burnett County Office of Zoning Administrator �� 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. o <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 <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the lawsand regulations of the State of Wisconsin. 3 a <br /> � �� M <br /> ... � ............................ - <br /> N ; <br /> OWNER (please print) CO RACTOR or.SU.RVEYOR or AGENT e <br /> M <br /> T <br /> a <br /> ................... <br /> ..... . . . ............................................................................... .ADD..... R....ES............................................................... m <br /> ADDRESS S m <br /> ..... ... . ............................................................................... ............................................................................................ <br /> ADDRESS ADDRESS <br /> ........................................................................................... ............................................................................................ ..(N <br /> PHONE. ............................................................................... PHONE <br /> PLUMBER WELL DRILLER G <br /> �\ <br /> . . . . .............................................................................. ............................................................................................ _. <br /> ADDRESS ADDRESS n o <br /> < l\ <br /> PHONE PHONEH <br /> Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° ° <br /> 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New BuildingNo. Bedrooms <br /> .......... Type of Construction: """"" <br /> Addition .................................................... Septic Tank Size Gals. .......... <br /> .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading g 4a. Absorption Field Site: 11 '• . <br /> .......... Height............. Stories ............... <br /> Moving .......... Area ........................................... Soil Type .................................... r <br /> o <br /> Mobile Home Slope .......................................... <br /> .... . . i .. <br /> >,_' <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well ••........ home,garage, motel, etc.) Dry Well .......... I 1 <br /> Subdivision ✓ Seepage Trench .......... <br /> .......... .................................................... <br /> Camping UnitPrivy .......... i <br /> .......... .................................................... <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road p <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 e <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: '. <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> p <br /> N O <br /> o � <br /> 4 V O <br /> S <br /> 1: 3 <br /> F ; t <br /> Z \ <br /> 0 <br /> d <br /> m <br /> N r N 0Z <br /> n to Q < m 2 F <br /> In <br /> o mn <br /> Z o Vim ` <br /> oa > n l <br /> o n 9 <br /> FA <br /> O <br /> O <br /> dr�'7 <br /> 5. <br /> ........................................................................... .. <?'C.. ......... p <br /> Signature of Owner or Agent Date <br /> ``7� , -I-I is a / 42 r x <br /> Remarkstl......�.M. .T.'r.!.Ici..>F..!...............�......................Y.�..................................................................................... <br /> m . <br /> ........................................................................................................ .. .................... ... :� . . . . . . <br /> Inspection Date ....................................... pi 'h U u o u 'o a <br /> li7QY.k.�... ...1.F.......... <br /> Zoning Adm ......... <br /> ✓........... <br /> trator <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures Involving sanitary facilities <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 />