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�?, I <br />Burnett County Office of Zoning Administrator v CD 0 0 <br />APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br />O <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N -^ 0 <br />shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD e <br />Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br />1J.�.. �. - x �-!`�. Y`.!P..........P1_ r?'� � .................... C m O <br />.................. .......................... <br />OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br />E........... .�-. ........................... ......... ..i ... . �f. ................................................. <br />ADDRESS ADDRESS CD <br />— <br />A.. ..................?.................... p <br />ADDRESS ADDRES� ?� <br />......................... <br />PHONE PHONE r <br />............................................................................ .............. ......-.36-A ..................................... <br />b <br />PLUMBER WELL DRILLER <br />V <br />O <br />ADDRESS ADDRESS CD o <br />:.... ....................................... O <br />PHONE PHONE Z N <br />DESCRIPTION 4. SanitaryFacilities: ° o ° 3 <br />1. Work: 2. New Building Details No. Bathrooms o �d <br />New BuildingType of Construction: No. Bedrooms .......... U; <br />Septic Tank Size Gals. r <br />Addition ... """"" ' <br />Sanitary .......... Size .............. ft. x .............. ft. .......... <br />Fillip /Gradin 4a. Absorption Field Site: <br />Filling/Grading .......... Height ............. Stories ............... <br />SoilType....................................Moving Area ........................................... r - <br />o <br />Mobile HomeSlope.......................................... + <br />...... <br />Privy .......... 3. Use (describe exactly, 1 - family Perc. Rate ................................... <br />Well,, home, garage, motel, etc.) Dry Well �p <br />Subdivision Seepage Trench .......... -k <br />Camping Unit Privy <br />.......... <br />.......... <br />.................................................... <br />Seepage Bed .......... � <br />---------------------------------------------------------------------- <n <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- c' Q <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 />Cn <br />CD <br />Or �`I) � J <br />O �t AOS V N p <br />Y' O 7 <br />o CD <br />IDWALK ot, <br />Cn r co Z <br />BASS-� cC cm <br />F. <br />m <br />Z 12D C <br />O N O n <br />O a� 3 <br />6q - <br />C) <br />m <br />v o C <br />Signature of Owne r Agent Date <br />X <br />Remarks......................................................................................................................................................................... CD <br />-n ; m <br />CD <br />o <br />......................................................................................................... ............................... <br />......... <br />Inspection Date....................................... ...............��?...............�'J............. <br />N Ds <br />mP <br />tZoning Administrator <br />0 0 0 0 0 0 <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 he made without approval of the Zoning Administrator. <br />SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />