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Burnett County Office of Zoning Administrator v o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < m <br /> v <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m N <br /> C w`'\ <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. _ a <br /> A71 <br /> �� ..CO... '/.................................... .. ..f.:....�S'we , � 3 0 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> a <br /> ..... . . ................................................................................. . . ........................................................................................ <br /> ........... ... ..... ... ....... .... ...... ....... .. <br /> ADDRESS . ... .. . . . . . ................. ADDRESS .. <br /> ............. . . ...... . ............................................................................ <br /> ADDRESS A..DDRES.. .SS <br /> ............ <br /> ........................................................................................... .P.H.ONE. ........................................................................ <br /> PHONE S v <br /> ........................................................................................... ............. . ............................................................................ <br /> L <br /> PLUMBER WELL DRILLER .� <br /> ........................................................................................... ....................................................................................... <br /> : O <br /> n <br /> ADDRESS ADD. . RESS : <br /> n <br /> _. <br /> ........................................................................................... ............................................................................................ 0 .: <br /> PHONE PHONE Z° <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: o ° <br /> 1. Work: 2. New Building Details No. Bathroomso <br /> .......... <br /> New Building .......... Type of Construction: No. Bedrooms .......... �V <br /> Addition .......... ..............................I..................... Septic Tank Size Gals. .......... <br /> Sanitary Size ft. x ft. .......... ' <br /> FiilinglGrading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving <br /> Soil Type .................................... <br /> ....... .. Area ........................................... r <br /> Mobile i <br /> Home Slope ° <br /> .......... <br /> .......................................... ^ <br /> Priv Perc. Rate ................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Well <br /> We <br /> Well .....,,,,, home,garage, motel, etc.) Dry •• •• • <br /> Subdivision ,�/,,, Seepage Trench .......... <br /> Camping Unit .......... .................................................... Privy <br /> .................................................... Seepage Bed <br /> .......... <br /> --------------------------------------------------------------------- <br /> Location of proposed structures and existing structures, well,sewage systems, roads, etc., should be sketched in Fig_ A_ Include road <br /> O' <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <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. p <br /> 0 <br /> — --__.--------------- ----------------------------------------------.—_ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> N O <br /> Y lJ /1a 3 7 � 3�, a 3 `J 1 � �j <br /> � c <br /> 2. <br /> I D`n <br /> C �' I z :Z <br /> b1 <br /> C) <br /> X rna :E N im Z <br /> m n C = y n <br /> -o < <br /> v, . m <br /> z o na <br /> 0 ° <br /> 0 <br /> :k1 O 31 <br /> L) M m <br /> O <br /> Sign'at uwner or Agent De at :�° <br /> re of C <br /> X M <br /> Remarks ......................................................................................................................................................................... <br /> le r v <br /> m <br /> � <br /> ° <br /> ........................................................................................................................................................................................ - <br /> II <br /> ............................................................................................. ... <br /> N ro N m <br /> ............. .............. .... .......................................... <br /> Inspection Date ....................................... �??'? ... J....................... . . . . . U <br /> Zoning Administrator KJ i 'c $ 0 0 0 0 0 y <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 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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />