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Burnett Count -� <br />Y Office of Zoning Administrator cn _0 z0) CD 0 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 located as <N <br />0 <br />shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br />Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a �/►�.� <br />............................................................................................ N <br />OWNER (please print) CONTRACTOR or SURVEYOR or AGENT MCgD <br />:� CD <br />r �}q <br />�...d.................................................................... <br />ADDRESS <br />o ice^ <br />ADDRESS °I <br />......................................................................................... = <br />C <br />ADDRESS ADDRESS <br />PHONE PHONE" <br />................................................................... <br />PLUMBER WELL DRILLER .� <br />ADDRESS ADDRESS C) <br />h o <br />-' <br />PHONE.............................. ............................... zo <br />PHON.E..................y r0DESCRIPTION 4. SanitaryFacilities: o» <br />: fC} <br />' <br />1. Work:No. Bathrooms <br />2. New Building Details <br />New Building ✓ Type f Construction: No. Bedrooms .......... <br />Addition Q Q �,,,,,,,���% Septic Tank Size Gals. .......... <br />_ t" / <br />.................... <br />Sanitary r� <br />v: <br />.......... Size .............. ft. x ...�... ... ft. <br />Filling/Grading .......... Height .... ►?..... Stories ✓ 4a. Absorption Field Site: <br />Moving .......... Area .....:.... Soil Type.................................... m <br />Mobile Home .......... Slope .......................................... 4 <br />o E <br />Privy.......... 3. Use (describe exactly, 1 -family Perc. Rate................................... <br />k. <br />Well .......... home, garage, motel, etc.) Dry Well .......... <br />Subdivision Seepage Trench <br />............... <br />Camping Unit ..........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- a <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. 'j, ti <br />o� <br />---------------------------------------------------------------------- <br />\ Fig. A. 6. Lcation ....... - <br />N,Q Q CD <br />0 o. <br />Qj �-, <br />\ \ LO <br />.\ <br />N <br />o <br />VyN. � v �. <br />Lo <br />CD <br />� j G� � -Cnr•v �.N W z <br />0 CON <br />/i �/ m71 jA <br />c m, w c m <br />Cn <br />on <br />.� CD <br />_ � rr <br />rr <br />it ' ... ...:>��..:. <br />Signature o caner or Agent Date P, o — <br />X 7 <br />rr <br />Remarks......................................................................................................................................................................... TCD <br />C <br />CD <br />u <br />............................................................................................................. ...............1........................................... k . . . . . <br />O CT O 00 O <br />Inspection Date....................................................................9........................................... :.. <br />Zonin lgdministrator �• 0 0 0 0 0 <br />NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitie4• <br />before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must he attached to <br />this application before a permit will be issued. Do not purchase or install a septic tank, do any plum hing 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 he made without approval of the Zoning Administrator. <br />SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />