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<br /> Burnett County Office of Zoning Administrator c 0 0
<br /> APPLICATION FOR SANITARY — 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 < N ��
<br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use m C 2.\s
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and re ulatious of the State of Wisconsin. a
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR o AGENT a
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<br /> ADDRESS ADDRESS
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<br /> ADDRESS RES
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<br /> PHONE PHONE
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<br /> PLUMBER WELL..DRILLER y
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<br /> ........................................................................................... .AD......DR...E..SSS—S' ...........................................................................
<br /> ADDRESS C)
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<br /> PHONE PHONE Z H r
<br /> DESCRIPTION 4. Sanitary Facilities: ° o
<br /> 1. Work: 2. New Building Details No. Bathrooms .......... o
<br /> New Building ,,,,,,,,,, Type of Construction: No. Bedrooms .......... ' n
<br /> Addition .......... .................................................... Septic Tank Size Gals. .......... » i
<br /> Sanitary .......... Size .............. ft. x ft. ..........
<br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site:
<br /> Moving Soil Type ....................................
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<br /> Mobile Home .......... Slope .......................................... 0
<br /> Privy y, y Pere. Rate ...................................
<br /> .......... 3. Use (describe exact) 1 -Tamil
<br /> Well ,......... home,garage, motel, etc.) Dry Well ..........
<br /> SubdivisionSee
<br /> page Trench .......... i
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<br /> Camping Unit ,,,,,,,,,, Privy ..........
<br /> .................................................... Seepage Bed
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<br /> Location
<br /> ________________ _Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road C
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<br /> setback, side and back yard dimension and location and setback from all bodies of water. If 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 EXISTING
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<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0
<br /> ------------------------ ---__________________________________________5. Lot Size: Fig. A. 6. Location:
<br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... i
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<br /> Signature of Owner or Agent Date X C
<br /> Remarks ......................................................................................................................................................................... m
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<br /> Inspection Date ....................................... m
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<br /> Zoning Adminiftrator K J $ o o $ o g 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 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 lie 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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