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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 />r!!.N..........?....C..................................... .../�..:.%1../-'.c.%..t�CS' <br />OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br />S`�„33... ,.c��,s.:�....�u..C. ....s ?'`....3.... ox...3d.......... I ............................ <br />ADDRESS ADDRESS <br />Mp Is......./.�1. '!1W......- .:-s:.`��� ...... ........&.i ..... .sy.k.3.d <br />............ <br />ADDRESS ADDRESS <br />4S6`.. <br />................................................................ ..........................................................I.............. <br />PHONE PHONE.......... <br />.......................................................................................................................................... <br />PLUMBER WELL DRILLER <br />ADD.......................................................................................... <br />ADDRESS RESS <br />.................................................................................................................................................. <br />PHONE PHONE <br />DESCRIPTION 4. Sanitary Facilities: <br />1. Work: 2. New Building Details No. Bathrooms ......... <br />New Building .......... Type of Construction: No. Bedrooms ......... <br />Addition.... Septic Tank Size Gals. ......... <br />Sanitary .......... Size ..... : -:xy ft. x .. ft. ......••• <br />Filling ...•...... Height .....7..... Stories ............... 4a. Absorption Field Site: <br />Moving.......... Area ........................................... Soil Type ................................... <br />Grading......... Slope ......................................... <br />Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate .................................. <br />Privy .......... home, garage, motel etc.) Dry Well ......... <br />Well .......... .......adz. ....rn-[J.+t!c.!l. Seepage Trench <br />Subdivision e�C.St.r7!nrJ...fc.ct�i!?.......... Privy <br />Seepage Bed ......... <br />---------------------------------------------------------------------- <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 />5. Lot Size:Fig. A. 6. tion: <br />AsX> ....... ft. x ...30.3 ... ft. — ............................... sq. ft. %Zl.....7.t%[�./11... 12.1.461.0 ............... <br />Z=a��,�Owner or Agent Date <br />Remarks......................................................................................................................................................................... <br />............................................................................................................................................... <br />Inspection Date ....................................... .......'...G/!.....�` "Lc-f�G�v, <br />................................... <br />Zoning Administrator <br />Cn v CD 0 z <br />0 3 o <br />h <br />�4-• <br />CD <br />CD c <br />0- <br />rt o <br />CD <br />CD CD <br />CL <br />:N, <br />O <br />Z N r - <br />a o 0 <br />T <br />0 <br />L <br />Z <br />0 <br />GI c <br />o' <br />Z <br />CD <br />0 <br />0La <br />E� <br />h <br />W <br />:-n �. <br />CD <br />v <br />7 <br />CD <br />CD <br />C/) Cn oo <br />CDz <br />'CD <br />< <br />o < C m <br />Z O O CD ]0 <br />o -0: <br />:per m <br />o C <br />X 70 <br />-n m <br />CD <br />CD <br />v <br />cn <br />0 0 0 0 0 0 0 <br />VOTE: 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 />Nith 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 />