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<br /> Office of Zoning Ad fnlstratorT"5W FOR SANITARY — LAND USE BUILDING PERMIT
<br /> AQ'ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described end located as a '� -o«
<br /> �! .i. Thi undersigned agrees that all work shall be done in accordance with the requirements of the Burnett Cou ty Lend Use`, m c I
<br /> SenlWa fopi Coda,and with all other applicable County Ordinances and the laws and regulations of the State f Wisconsin.'' 3
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<br /> ' ' ` CONTRAC �if RVEVOR or AUNT -
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<br /> PHONE _•�' ' ................................... .PHONE
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<br /> PLUMBER .. t. ............................................................... .....,...,................................... ...........
<br /> s WELL DRILLER \
<br /> RES. // .T f h ADDRESS ..................................... .:.. : -.....�
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<br /> PHO ,Y.. . Pti•.
<br /> I DESCRIPTION 4. Sanitary Facllltlesl r`t• t, r rt •rig. ? 0
<br /> 1. Work " No. Bathrooms.-
<br /> ,New
<br /> athrooms ! .
<br /> _ _ 2. New Building Details pA
<br /> ,clew Building ; Typeof Construdtioh: No. Bedrooms °
<br /> Addition. .......... .................................................... Septic Tank Size Gals `�lJs9.�j i.�l 3 .
<br /> v Size .............. ft. x .............. ft.
<br /> i4wtkryFilling •~ -• Height............. Stories ............... 4a. Absorption Field Site
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<br /> Moving -.......... Area ......................:.................... Soil Type ..,...,...,nn.,
<br /> Grading -u Slope ...a.i................. .
<br /> Mobile Home- .......... 3. Use (describe exactly, i -family' Parc. Rate.. . ,- t it
<br /> Privy home,garage, motel,etc.) - .Dry Well _
<br /> Well �,.,. Seepage Trench -
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<br /> Subdivision f. Privy
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<br /> . . .. . ... I Seepage Bed ', ....1... i
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<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 locatedNO at a hl hway Inter- .. ErL
<br /> section, show theIlittersecting highways and the setbacks required along them and at the intersection..CLEAR LV LABEL EXISTING "- II' +++
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. P:r :1 T
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<br /> 5: Lot Size:: Fig. A. 6. Location: y, // �J
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<br /> .Signf Owner or Agent Date
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<br /> Remarks ......................... m . . .
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<br /> InspectionDate .....................................
<br /> Zoning Adm istrator . ;p., tN, 0 0 00
<br /> NOTE:. A preliminary site inspection must be made and site approval granted on all structure involving sanitary facilities
<br /> befor', construction can begin. In the case of sewerage disposal systems, a copy of the percolat ori'testifnust [)a 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 of specifications shall not be made without approval of, the'Zoning Administrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED 'BY' THIS OFFICE ANb APPROVED.
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