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Burnett County Office of Zoning Administratord o U,
<br /> APPLICATION FOR SANITARY — C.
<br /> LAND USE — BUILDING PERMIT 3
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<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
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. o-
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<br /> OWNER Ipl ase print)
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<br /> 7 '7^ CONTRACTOR or SURVEYOR or AGENT m m
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<br /> A .........(.�.' ....................... .ADDRESS............................................................................
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<br /> PHONE
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<br /> PLUMBER WELL DRILLER tj
<br /> ADDRESS ADDRESS
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<br /> PHONE ...H..O....................................................................................... �Z H ,:
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<br /> DESCRIPTION 4. Sanitary Facilities: ° o 0
<br /> 1. Work:
<br /> 2. New Building DetailsNo. Bathrooms ••• ••
<br /> New Building 7' T e f Con cti No. Bedrooms .......... 'Oo
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<br /> Addition ..,.,...., ,. Q.I.C5-•/,•„ .E„l,� ,,;✓ Septic Tank Size Gals. ..........
<br /> Sanitary Size ..sl.:`T..... ft. x ... .�.. ft. ••••••• i
<br /> Filling/Gradingy 4a. Absorption Field Site:
<br /> .......... Height............. Stjgips ............... _ :
<br /> Moving .......... Area ........,9.1.0........................... Soil Type .................................... l^� : Z.
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<br /> Mobile Home .......... $OPe .......................................... :� o
<br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ............................. .....
<br /> Well ho e,garage, motel, etc.) Dry Well .......... p
<br /> Subdivision C Seepage Trench ..........
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<br /> Camping Unit ,.,,,,.,,, Privy ,,,,,,,,,,
<br /> Seepage Bed .......... ��� :(n
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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 O i
<br /> setback, side and back yard dimension and location and setback from all bodies of water. It property Is located at a highway inter d
<br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS.
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<br /> 5. LoJ„�ze /�O Fig. A. 6. Location:
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<br /> Signature of caner or Agent Date o C
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<br /> Remarks ............. T m
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<br /> Inspection Date ....................................... ...... � `%'.GtGU.L..... .. ..7��................,.
<br /> Zoning Ad nistrator 80 g g g o
<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 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 or specifications shall not be made without approval of the Zoning Adm mistratoi.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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