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7.-7 C-07-7 t <br /> Burri6tt Courhty Office of Zoning Administrator ;v CD o z <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 0 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseCD c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 C- V <br /> L <br /> ..... .......................:�'.�F...................................................... C O <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a ID <br /> ' :....CZ .......... .A........../?n.w............................ .............................................................................. - <br /> ADDRESS ADDRESS <br /> ADDRESS <br /> '�...�f/ .......................... ... .. .. �2 <br /> ............................................................................. <br /> .............G. .�...�:... <br /> PHONE t PH <br /> ....................................................... <br /> PLUMBER ` WELL 17'.. . ... ................................................................... . <br /> r �Va <br /> . ... v <br /> ADDRESS 'RESS CD <br /> 0 <br /> ................................................................................ ............................................................................................ -' <br /> PHONE PHONE o <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° L <br /> v <br /> 1. Work: 2. New Building Details No. Bathrooms ....2,.. :N o � <br /> New Building ... Type of Construction: No. Bedrooms ... <br /> Addition Septic Tank Size Gals. ...... ... <br /> 4 -< <br /> Sanitary aC.... Size ..:1-`f.... ft. x ...t q.... ft. <br /> Filling ;1(..... Height....V...... Stories .....1......... 4a. Absorption Field Site: <br /> Moving .......... Area ........g.f..U........................ Soil Type .................................... <br /> �. <br /> Grading .......... Slope .......................................... <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> y .•.• home,garage, motel, etc.) ......••• <br /> Privy Dry Well <br /> Well �• ( Seepage Trench <br /> ....... .. ...y....................... ...y® , <br /> Subdivision Privy ..�... <br /> ...�,.�.... ' ........:�..�'.......... �+ ; <br /> Seepage Bed <br /> --------------------------------Z X r=v L————————————————————————————— N '7�, <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- I _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 /> ----------------- <br /> 5. Lot Size: �L Z f?C> Fig. A. 6. Location: <br /> ft. x .............. ft. — sq.ft. ............................................................................... CD <br /> Cn <br /> o 0 <br /> J t , <br /> N � <br /> Jb o <br /> CD <br /> m <br /> ' <br /> m co` <br /> n /`5 0 0 0' CD <br /> o =i <br /> v6V j CD <br /> m <br /> Signature of Owner or Agent ; Date 0C <br /> Remarks v q -t X m <br /> /............... ...'! � .:. � ��4..L* •r'!1.... .7.�.` ................................................ CD . <br /> ' CD v <br /> .......................................................................................................................................................................................° <br /> ............................................................................................................... <br /> Inspection Date <br /> - o00 ocNnrn <br /> ................. <br /> Zoning <br /> Administ for C: 0 C 0 0 0!m/� <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faVI tic <br /> - <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> ,iis application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> Ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> lith 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 />