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Burnett County Office of Zoning Administrator C - 0 0 <br />3 . <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 UseCD <br />m { <br />Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 p <br />............................................... G� ':`:••.•..........:.... •-•':..................................... C m <br />O <br />OWNER/Iplease print) CO RACTOR o URVEYOR or AGENT a CD <br />CL <br />ADDRESS <br />"S".....,.GcJ <br />S ...........1...........Y....9 ............................. <br />ADDRESS ADD....R"ESS .� <br />............ <br />PHONE PHONE <br />....................................... ...... <br />........................................... :� v <br />PLUMBER W..ELL D..RILLER <br />.........................................................................AD.....D..RES"'E'S"S.............................................................................. —. <br />ADDRESS co � <br />h o <br />. ... ........... : <br />PHONE PHONE Z N r <br />DESCRIPTION 4. Sanitary Facilities: ° o ° <br />1. Work: No. Bathrooms <br />2. New Building Details o <br />New Building Type of Construction: No. Bedrooms .......... c <br />CD ; <br />Addition <br />Septic Tank Size Gals. <br />Sanitary ....•..... Size .............. ft. x ft. ......•••• <br />Filling/Grading 4a. Absorption Field Site: <br />.......... Hei ht .............Stories ............... i <br />Moving Soil Type .................................... <br />.......................................... r <br />o <br />Mobile Home Slope ................................. I........ '+ <br />.......... <br />Privy .......... 3. Use (describe exactly, 1 - family Perc. Rate ................................... <br />Well home, garage, motel, etc.) Dry Well .......... <br />.. �.. <br />Subdivision Seepage Trench .......... <br />Camping UnitPrivy .......... <br />.......... . . <br />Seepage Bed <br />-----------------------------------------------------------r---------- N <br />Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road C <br />setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- _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. N /\ <br />---------------------------------------------------------------------- <br />5. Lot Size: Fig. A. 6. Location: <br />ft. x .............. ft. — ............................... sq. ft................................................................................ <br />y � CD <br />N o <br />O M <br />� i R <br />ED <br />CD <br />I <br />DO Cnr--oc coZ <br />CD <br />< — C CDa <br />-o• cn < y = C -v <br />Z 0a-. Dam <br />O , G 3 <br />t . _ <br />CD <br />..����............. � p <br />o <br />C <br />Signature of Owner or Agent Date . . . . . . <br />X : : : : : : 70 <br />Remarks T . . . . . . m <br />CD <br />........................................................................................................................................................................................ — <br />............................................................................................... ..................<.......................................................... ; \ ,C <br />,Q aQ M <br />Inspection Date ....................................... ��ilT�4Q.1..........oo o o °� o m <br />e: <br />Zoning Administrator '�✓ c $ $ $ $ $ o N <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 />fvith 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 />