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Burnett County Office of Zoning Administrator U - 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 0 ,\
<br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as <
<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 /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0_ imp
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a
<br /> a : k.ADDRESS ........ ........ .... .... . . . ..... ..... . .... ..........
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<br /> ADDRESS ADDRESS �W
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<br /> PHONE. ............................................................................... PHONE
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<br /> PLUMBER WELL DRILLER
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<br /> DESCRIPTION 4. Sanitary Facilities: ° o °
<br /> 1. Work: 2. New Building No. Bathrooms """"
<br /> Details " o i
<br /> New BuildingNo. Bedrooms ......... : '0 .•>t1\y
<br /> .........• Type of Construction:
<br /> Addition .......... .................................................... Septic Tank Size Gals. ..........
<br /> Sanitary .......... Size ft. x ft. """"" '
<br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site:
<br /> Moving .......... Area ........................................... Soil Type .................................... o
<br /> eSlop ..........................................
<br /> Mobile Home ..
<br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ...........................I....... i
<br /> Well •......... home,garage, motel, etc.) Dry Well ..........
<br /> Subdivision Seepage Trench ..........
<br /> .✓... ..... ............................................
<br /> Camping Unit Privy ..........
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<br /> Seepage Bed ..........
<br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig_ A. Include road p.
<br /> setback, side and back yard dimension and location and setback from all bodies of water. It property Is located at a highway Inter- O-
<br /> section, show, the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING m
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o
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<br /> 5. Lot Size: Fig. A. 6. Location:
<br /> ................ ft. x .............. ft. - ............................... sq.ft. ............................................................................... i
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<br /> Signature of Owner or Agent Date X
<br /> Remarks ......................................................................................................................................................................... ro + m
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<br /> Inspection Date ....................................... ,� o m
<br /> ,,,,,,,,,,,,,,,Zonin Administrator•,.KJ,,,,,,,,.,,,, 8 8 8 8 8 8 cn
<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 lie made without approval of the Zoning Administrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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