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Burnett Cl Office of Zoning Administrator - - o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR- 7"he undersigned hereby makes application for a Permit for the work described and located as o <br /> shown herein. The uneers l gned agrees that al I work shall be done in accordance with the requ l rements of the Burrett County Land Use ,� c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the Slate of WisFonsin. <br /> .................... ................ ...... .. . <br /> ... .......... <br /> NER please print) t CONTRACTOR or SURVEYOR or AGENT M .O 0 <br /> I- 0P. <br /> a .........God ........ ........ .......... .......................................................................................... c <br /> ADDRESS ;'\l <br /> ....................................................................................... . <br /> .... = v <br /> ... . . . <br /> ADDRESS <br /> ADDRESS. �l <br /> ...................... ..................... ........ <br /> PHONE <br /> PHONE <br /> ........_.............. <br /> ON <br /> PLUMBER WELL DRILLER <br /> ADDRESS ..... ........................` 1.. <br /> .:. ............ <br /> ADDRESS <br /> _. <br /> ........................................................................................... <br /> PHON.E............................ No. Bathrooms - o <br /> PHONE <br /> .................. ............ <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details <br /> New Building .,, .. Type of Construction: No. Bedrooms i.......... •� m \ <br /> Addition ......................GV (j fi?19•n7L`" Septic Tank Size Gals. .._...... <br /> ....... .. IVnf <br /> Sanitary .... .. Size .ca�! .... ft. x ...T�..B.�. ft. i <br /> Filling/Grading Height.......... Stories .....1........ 4a. Absorption Field Site: <br /> Moving ......,,,, Area <br /> ii................ Soil Type 'r......... v <br /> Mobile Home Slope ........., <br /> Privy <br /> 3 Use (describe <br /> exactly, amilY Rate ................... ..... <br /> Well ...DChmgarae, motel, etc.) <br /> Pere. <br /> yWell <br /> E <br /> Subdivision .......... '� Seepage Trench .......... <br /> .............SP..�=� ....C'Ar.S.I'll... <br /> Camping UnitPrivy <br /> --------------- .. . .... . .... .. — --- ---- Seepage Bed ...... iV1 <br /> Location of proposed structures and existing structures well, sewage systems, roads etc- should be skUched in Lig. A. Inc Use road e <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If pr inn ty G located at a highway intera <br /> section, show the intersecting highways and the setbacks required along them and at the 'intersect on. <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. CLE F [ LABEL EXISTING 61 <br /> —_. ---------------___----_---_.._ — ` <br /> 5. Lot Size: D Fig. A. 6. cation: q <br /> /5�1..... ft. x . < ...... ft. . ............................... sq. ft. <br /> UA40ti 4 DA IG[A*tJ iw u <br /> `lon <br /> c9N <br /> o c w <br /> I rr r €-b I <br /> le <br /> 7a � Vl r�v �wm � <br /> c <br /> _. mm <br /> 0 0o n ' <br /> v _ in 3 <br /> ( � r Ca <br /> .�' � "1 V Gf 8 96 m <br /> ............e—of.... -ner......... . . ......................... .... . <br /> Signature of Owner or Agent Date : ° C <br /> X 70 <br /> Remarks ...................................................................................................................................................................'. T m <br /> v <br /> .I <br /> ........................................................................................................... x: <br /> Inspection Date ....................................... ..... . . ... m <br /> Zoning Administr <br /> NOTE. A preliminary site inspection must be made and s e ""wroval 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 he issued. Do not purchase or Install a septic tank, do any piui'nbing or Stan 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 />