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Burnett County - Office of Zoning Administrator <br />APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <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. <br />IN�Eioi(�'Pl_eZ 1pri n*t*.. CONTRACTOR or SURVEYOR or AGENT <br />AD KESS ADDRESS <br />u..Q,�.c?.n...:..........5:..y..�.�..l.......................................................................................................... <br />ArSS ADDRESS <br />............••.................................................................... <br />PHONE PHONE <br />.........•............••.................................................................. <br />PLUMBER <br />.....•....••.•••.......•••.•.....•............. <br />ADDRESS <br />......................................................................................... <br />WELL DRILLER <br />ADDR........ESS............••....•..................................•.•.......•••............... <br />......................................................................................................................... <br />PHONE PHONE <br />Z r <br />�+ <br />° o ° ^5 <br />:s.F <br />o <br />?�CD <br />.......... , 6' <br />Cn v <br />_ <br />--iZ <br />0 <br />0 <br />CD <br />3 <br />Building <br />...X... <br />Type of Construction: <br />Addition <br />r Q ww �,...... <br />Sanitary <br />... <br />................. . ....... <br />Size a ft. x � � ft. <br />.... . ... ............. <br />Filling <br />.......... <br />mCL <br />Moving <br />:UJ <br />Area ........................................... <br />Grading <br />o' <br />:T <br />Mobile Home <br />a <br />� <br />3. Use (describe exactly -family <br />O_ <br />N <br />r+ <br />Well <br />CC <br />G <br />M <br />a <br />Subdivision <br />N. <br />Or <br />CD <br />0 <br />x <br />„ <br />m <br />CD <br />o: <br />cn <br />00000c"'i,m <br />CD <br />AN <br />p <br />d <br />o <br />CD <br />CD <br />0 <br />141 <br />DESCRIPTION <br />CD C N <br />0, Naa•<G <br />1. Work: <br />New <br />CD <br />2. New Building Details <br />Building <br />...X... <br />Type of Construction: <br />Addition <br />r Q ww �,...... <br />Sanitary <br />... <br />................. . ....... <br />Size a ft. x � � ft. <br />.... . ... ............. <br />Filling <br />.......... <br />Height ............. Stories ..............• <br />Moving <br />.......... <br />Area ........................................... <br />Grading <br />o' <br />:T <br />Mobile Home <br />.......... <br />3. Use (describe exactly -family <br />Privy.......... <br />home, garage, motel, etc. <br />Well <br />'a.,� <br />p <br />Subdivision <br />.. <br />.................................................... <br />4. Sanitary Facilities: <br />No. Bathrooms <br />No. Bedrooms <br />Septic Tank Size Gals. <br />4a. Absorption Field Site <br />Soil Type ................. <br />Slope....................... <br />Perc. Rate ................ <br />Dry Well <br />Seepage Trench <br />Privy <br />Seepage Bed <br />Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road <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 <br />STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br />------------------- <br />---------------------------- <br />5. Lot Size: FigA. 6. Location: <br />................ ft. x .............. ft. — ............................... sq. ft................................................................................ <br />N <br />r <br />.4 . .... . .... . �....... ............................... <br />Signature of Owner or 4gent Date <br />Remarks.S::�.......'................................................................................................................... <br />a�.. . .��: fi........................................................................................................................... <br />..... ................. <br />Inspection Date 7.` <br />..-3 ............. Y <br />...........I..r�. t..................... <br />Zoning...Administrator <br />M Cn <br />CD C N <br />0, Naa•<G <br />CD <br />0 y C <br />i <br />Q <br />.R c <br />03'CD <br />G <br />CD <br />I <br />N <br />Q <br />o' <br />:T <br />:W O <br />n <br />'a.,� <br />p <br />J <br />M <br />0 <br />x <br />„ <br />m <br />CD <br />o: <br />cn <br />00000c"'i,m <br />CD <br />0 <br />0 <br />d <br />CD <br />CD <br />M Cn <br />CD C N <br />0, Naa•<G <br />CD <br />0 y C <br />03'CD <br />CD <br />OZ <br />:W O <br />:SCD <br />p <br />o <br />x <br />„ <br />m <br />CD <br />o: <br />cn <br />00000c"'i,m <br />DOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br />efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br />his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build - <br />ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br />vith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br />SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />