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Burnett County Office of Zoning Administrator o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT a <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and " 6 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 `8 <br /> regg Uations of thq Slate of Wislc�onsin. ' ^ d <br /> .W..!!.!"...'?.�..•//.yt p:.vr...: R.L.S. .. S d C I L <br /> ......... .... . .. ..... ............................................................................... ...... <br /> ER (Please pri 1 CONTRACTOR or SURVEYOR or AGENT p e <br /> p ..... - . <br /> ADDRES ADDRESS � :�`•� <br /> �j!. .r...... '...1........................................... . .......................................................................................... <br /> ADDRESS. . ADDRESS <br /> 00 . <br /> PH NE PHONE <br /> .. # .!�. ......................................................... . ... . . . . .. . . . f <br /> ....................... ....... <br /> PLUMBER WELL DRILLER <br /> O <br /> ADDRESS ADDRESSn O <br /> ........................................... ....... o <br /> ........................................................................................... <br /> . . ............................... :H <br /> PHONE P..H..ONE.. .. Z � r- <br /> DESCRIPTION 4. Sanitary Facilities: <br /> No. Bathrooms v <br /> 1. Work: 2. New BuildingDetailsNo. . """. <br /> New Building Type of Construction: Sep Bedrooms .. ....... <br /> iqj <br /> Addition Septic Tank Size Gals. .......... <br /> ?/!/.s.�rlaj............... Do <br /> Sanitary .. .... Size .............. ft. x .............. ft. .......... i <br /> Filling/Grading ...•. Height............. Stories ............... 4a. Absorption Field Site: <br /> Soil Type .................................... <br /> 1-1 <br /> Moving .......... Area n <br /> Mobile Home .......... Slope ................................. ........ <br /> :04- <br /> Perc. Rate .......................... ........ F, 1-y <br /> Privy .......... 3. Use (describe exactly,� -family m o <br /> Well .,,,,,,,,, home,garage,motel,etc.) Dry Well . ........ _ <br /> Seepa a Trench Z <br /> Subdivision g •• O <br /> Camping Unit .......... .................................................... Privy . .. ..... a <br /> Seepage Bed . ........ <br /> --------------------------------------------------------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the interse tion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ___ .a ;S 0 <br /> _____________________________________ _____ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ________ <br /> ................ ft. x .............. ft. — ............................... sq.ft. <br /> O � <br /> O <br /> N O <br /> O J <br /> J <br /> O <br /> 0 <br /> O <br /> f <br /> T` J <br /> I a'`w` <br /> Z l <br /> O <br /> 9 <br /> J <br /> I ' 4U� <br /> I 31 W M W r D co W -0 <br /> � m <br /> m Nn�< ' nm na y <br /> 9 < d C o J J ; <br /> N Oa] m <br /> Z fqO : ) D 1 <br /> c'Ja Nn : S <br /> OD <br /> : p <br /> 2J <br /> A <br /> In <br /> ...••'.1••......... ......... .. . . . ............................. ...................................... a 0 <br /> In <br /> Signature of caner or Agent Date e <br /> N <br /> � <br /> / n <br /> Remarks ...2./ <br /> . ..................................................................................................................................... . <br /> ................................................................................................................................................................................ ....... N O <br /> ........................................................................................................ .. .............�.. <br /> ?.. gAdministr for.......y .... O8 <br /> , mInspection Date .•....... $ 88rTnZonin d <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary acilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this ap lication before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans r specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND PPROVED. <br />