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Burnett County Office of Zoning Administrator d 0 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 y r
<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 m G
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin.
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<br /> OWNER (
<br /> please
<br /> print) CONTRACTOR or SURVEYOR or AGENT a
<br /> ADD ESS ADDRESS r
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<br /> DDRESS . 5-� 0F
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<br /> PHONE PHONE \�
<br /> ........................................................................................... 'W"'E"L......RI-LLEI.R....................................................................
<br /> PLUMBER WEL D
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<br /> ADDRESS 'O
<br /> ADDRESS ........ ..... . .. .................................................
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<br /> PHONE PHONE Z o' - i
<br /> DESCRIPTION 0
<br /> 4. Sanitary Facilities: ° o °
<br /> i. Work: 2. New Building Details No. Bathrooms ` �'�
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<br /> New Building {.. Typ f Construction: No. Bedrooms ..... .... .r
<br /> Addition ,,;/';q.;�,,t... .............. Septic Tank Size Gals. !�
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<br /> Sanitary Size ..... -,ft. x ....�.b. ft. •.-• C�
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<br /> Filling/Grading .......... Height.. . y, Stories ....., 4a. Absorption Field Site:
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<br /> Moving .......... Area Soil Type ....................................
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<br /> Mobile Home ......... Slope .................................... ..... PPP`
<br /> Privy ........,, 3. Use (describe exactly, i - family Perc. Rate ................................... i
<br /> Well ,,,,,,,,,, home,garage, motel, �tc.) Dry Well ..........
<br /> Subdivision ,,,,,,, Cr— r f' / k7� Seepage Trench .......... i
<br /> Q....Fs.. .G .../.... ..... .
<br /> Camping Unit ,,,,,,,,,, Privy ..........
<br /> .................................................... Seepage Bed
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<br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc_, should be sketched in Pin_ A_ Include road e
<br /> setback, side and back yard dimension and location and setback from all bodies of water. It 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 EXISTINGvl
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<br /> STRUCIURES AND PROPOSED STRUCTURES AND ADDITIONS.
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<br /> 5. Lot Size: Fig. A. 6. Location: v i
<br /> ................ ft. x .............. ft. — ............................... sq. ft. ...............................................................................
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<br /> Signature of Own or A/9�q�t /ate /
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<br /> Remarks ........... ......_l_.-' r fr S �.. ....Q T x an
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<br /> Inspection Date ....................................... G/..z.^��.. �eft....... ........ . ��
<br /> Zonin dministrator : o � 0 S
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<br /> NOTE: A preliminary site Inspection must be made and site approval granted on all structures Involving SuritalY facilltios-
<br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test most be attached to
<br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumhing 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.
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