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( p, <br /> Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and loci ted 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 C � <br /> Ordinance, Sanitation de, and with all other applicable County Ordinances and the laws and regulations of the State of Wls onsin. a <br /> ................................ ....I horrr2s...S °:.�l s t ..................... ......... N ° <br /> a <br /> OWNER <br /> (please...°.`print) <br /> CO,UT,RACTOR or SURVEYO rAGENT <br /> ............. ... ............,............. .....`..r..... a <br /> ADDRESS ADD ES <br /> d <br /> ADDRESS ADDRESS C <br /> i <br /> ........................................................................................... . . . . ....................................................................—............. <br /> PHONE PHONE <br /> ........................................................................................... <br /> PLUMBER .W..........D.RL................................................................................ <br /> ELL I <br /> ........................................................................................... p <br /> ADDRESS . .................................................................................... <br /> ADD......RESS n 0 <br /> n p <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... 10o <br /> New Building .....,,,,, Type of Construction: No. Bedrooms .......... <br /> addition .......... .................................................... Septic Tank Size Gals. .......... < <br /> Sanitary <br /> ......I... Size ft. x ft. .......... <br /> Eillingt Grading ....... Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving ........ Area Soil Type .................................... <br /> .. ........................................... <br /> Mobile Home Slope o ' <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well . .., ,.. home,garage, motel, etc.) Dry Well .......... <br /> Subdivision , Seepage Trench .......... <br /> J <br /> Camping Unit .................................................... Privy <br /> Seepage Bed . ....... <br /> ___________________ q . <br /> ___ <br /> wae sN ll <br /> Location of proposed structures and existing structures, well, segystems, roads, etc., should be sketched in FIg. A. Inclu e road <br /> setback, side and back property y g i <br /> Yard dimension and location and setback from all bodies of water. If ro erts located at a hi hwa inter- a <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection_ CLEARLY LABEL EXI 3TING < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 0 <br /> ------------------ ------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> .. . .. . .. ... ft. x ... . ....... ft. — ............................... sq.ft. ................................................................. . .......... <br /> n <br /> N <br /> (1 <br /> I r o <br /> 0 <br /> p <br /> rts <br /> T <br /> yJ � <br /> b <br /> V <br /> K 7c a an <br /> <' <br /> aM <br /> X z o a ; Bp <br /> l� F1K j �o <br /> .................. ....................................................... ...................................... o <br /> Signature of-0 wner or Agent Date .. . - <br /> X M <br /> Remarksbi : m <br /> .................................................................................................................................................................. ...... T� <br /> O <br /> ....................................................................................................... , . .� _ e .. ... . .nN. .o .:a .: :. .................. .....,,.... .. ,.... ........I..................... . : <br /> T <br /> Inspection Date ....................... . . ...... .... is, m <br /> Z5 <br /> Fri m <br /> j Zoning Administrator :C7 $ $ 0 0 0 00 to <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 huild- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the mf Dirmation conveyed here <br /> with is found to exist. Changes in plans or specifications shall not be made without approval oft e Zoning Ad ninistratm . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE ND APPROVED. <br />