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L/ <br />Burnett County Office of Zoning Administrator0 0 <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 < 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 <br />Or nce, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br />�..I�... ....1......� -...1.. 1� }art o <br />H CD <br />........... � ........ ..... ........................ � . <br />316D <br />ER (please print) CON ACTOR or SURVEYOR or GENT m <br />{ <br />5:....��...:........................... <br />�:......... a <br />...... <br />RESS y.. ADD SS <br />/. ? .... '`/ ?./?�4.5.....!9.c.> .��.....................��..L.............. <br />�t <br />w <br />ADDRESS ADDRESS <br />Z'707 -A..... i .... ,,f.'t AI ........................ .................. -.371 ................... <br />PHONE PHONE '� <br />......................... <br />PLUMBER WELL DRILLER <br />................................................. D <br />ADDRESS ADDRESS 0 o <br />f+ <br />......................................................................... :O O a <br />PHONE PHONE Z N r— <br />DESCRIPTION 4. Sanitary Facilities: o <br />No. Bathrooms <br />1. Work: 2. New Building Details """"" 0 <br />New Building .......... Type of Construction: No. Bedrooms ..... ro <br />Addition / Septic Tank Size Gals. .......... ,.�`: <br />............................................... <br />Sanitary Size ... ft. x ...Y�.. ft. """"" <br />4a. Absorption Field Site: <br />Filling/Grading Height Stories .............. . <br />g ,7 ...�Q' rr Soil Type .................................... ��: 0 <br />Moving Area ........... l... <br />Mobile Home .......... Slope .......................................... <br />Privy .......... 3. Use (describe exactly, 1 - family Perc. Rate ................................... <br />Well .......... home, garage, motel, etc.) Dry Well """"" <br />Subdivision ...............9.AK4..5..4: .................. Seepage Trench .. Privy ........ <br />.... <br />CampingUnit .............................................................. .. <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. Location: <br />................ ft. x .............. ft. — ............................... sq. ft. <br />k t <br />it, dy� <br />law] <br />lot PfuS <br />`................................ . ....... ....... 7...... ..o........... <br />Signature ofeOwner or !A�ggeennt c/ U Gy Date <br />Remarks`�.,1..�..,'& . ......1... ..7.../.................................................................................. <br />...................................................................................................................................................................................... . <br />........................................................................................................ .. <br />....................................................................... <br />Inspection Date ....................................... !?!!LQ......./-'.... ......... <br />Zoning Administrator <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 Administrator. <br />SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />o <br />Z <br />O : <br />n> <br />CDo <br />CD <br />�p Lo r v <br />Cn w <br />w Z <br />C C 7 ID <br />n Efl6 CL <br />CD' <br />0 <br />C. <br />U1ac <br />oy:D <br />`yam <br />Z oo <br />a 70 <br />o <br />a <br />V 1�CD0 <br />m <br />a <br />o <br />CC <br />X <br />m <br />CD <br />rn <br />:4: <br />o: <br />•� N •� OD - N rr <br />O fr O P O P rr <br />00 0 0 0 0 U <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 Administrator. <br />SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />