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Burnett County Office of Zoning Administrator C CD -00 0 <br />APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT. <br />: <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N o 31 � „t <br />shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use v <br />Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0 <br />............................�/.........L".4�..G�Z�.............................. <br />_ <br />O <br />o <br />OWNE (please print) CO TRACTOR or SURVEYOR o a <br />,...��i.....,..1..�Y.-3............................. <br />ADDRESS eESS °* <br />co <br />........................................................................................................................................................................... <br />ADDRESS ADDRESS <br />........... <br />PHONE.................................................................................PHONE...................................................................... <br />.......E......................................................................................................................................................................... <br />PLUMBER WELL DRILLER <br />................................................................................................................................................................... O <br />ADDRESS ADDRESS � O <br />0 o <br />o' <br />............ <br />PHONE PHONE <br />2y r <br />DESCRIPTION 4. Sanitary Facilities: ° 0 ° <br />1. Work: 2. New Building Details No. Bathrooms ......•••• c: o <br />New BuildingNo. Bedrooms .......... <br />.......... Type of Construction: 3 i <br />AdditionSeptic Tank Size Gals. a <br />.............................................................. t : < <br />Sanitary Size ft. x ft. .......... M: <br />Filling/Grading .......... Height ............. Stories ............... 4a. Absorption Field Site: <br />Moving Area Soil Type .................................... I— <br />.......................................... o ; <br />Mobile Home Slope .......................................... 5u ; .• <br />.......... <br />Privy....,..... 3. Use (describe exactly, 1 - family Perc. Rate ................................... `v <br />Well .......... home, garage, motel, etc.) Dry Well .......... <br />Subdivision.......... Seepage Trench .......... ; <br />................................................... <br />Camping UnitPrivy <br />.............................................................. <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 N e <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 EXISTINGGt1d1.6 �<— <br />STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0° <br />------------------------------ ---Jt. <br />5. Lot Size: Fig. A. 6. Location: <br />ft. x ft. s ft. _ <br />............. — .........................c..... q. <br />CD <br />N <br />o D <br />Lo <br />N <br />h <br />0 <br />ANN <br />:G T <br />cn vganwz <br />C <br />ID <br />; c <br />C <br />CD N Q. `< — m a Cc) <br />-p <• ,� c <br />y• m <br />Z D a <br />` l o .' <br />.............. ...........r...... o m <br />Signature of Owner or Agent Date <br />X <br />Remarks -n •� . . . . . . M <br />CD <br />Co <br />rfl ` <br />........................................................................................................... .................................................................... <br />4 0 �Nm <br />N au <br />Inspection Date ....................................... o cn o cn o v, <br />Zoni�;���nrator rc✓ 0 0 0 0 0 0 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 riot 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 />rvith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistrator. <br />SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />