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Burnett County Office of Zoning Administrator Y 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 loc ted as < 7 -" <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use � e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wis onsin. _ <br /> 3. <br /> o- <br /> Bruce..... ..S,.T.h..n .................... .... .................... ....... o <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> .. ..... . .... ..... a <br /> ADDRESS ADDR SS <br /> M.... <br /> . ........... .. .. ........... .... ..... ........... ............... . ..... c� .. .. .... ...... .... .... ..... .. ..... ........ . <br /> ADDRESS ADDRESS <br /> (�U:P ,....u�J ... hR3.. ..... .... <br /> PHONE PHONE <br /> ........... ................................. .. .... ..... ..... ... ........ ............................................. .... ....... ..................... . ...... . <br /> PLUMBER WELL DRILLER �!n <br /> O V 1 <br /> ADDRESS ADDRESS n o ^� <br /> ........................................................................................... .PHO'H'O".NE........................................... ............................ .......... <br /> PHONE � r <br /> DESCRIPTION 4. Sanitar.. Z <br /> Facilities: ° o ° <br /> 1. Work: -02. New Building Details No. Bathrooms .......... <br /> New Building No. Bedrooms <br /> .......... Type of Construction: a <br /> �o <br /> Addition ,,..••.••• ••••. ........ ..•.•. Septic Tank Size Gals. ........,. < <br /> Sanitary ,,,,,, Size ft. x ft. •""""' <br /> .... .............. ..... ........ <br /> Filling/Grading ...••..... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... <br /> o <br /> Mobile Home .......... Slope ............................... .......... -� <br /> Privy ••........ 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well home,garage, motel, etc.) Dry Well .......... <br /> Subdivision Seepage Trench .......... <br /> Camping UnitPrivy .......... <br /> .......... .................................................... <br /> Seepage Bed .......... <br /> --------------- ---------------------------------------------- — <br /> -- cn <br /> r etc., should be sketched in FI A. Inclu e road e <br /> Location of proposed structures and existing structures, well, sewage systems, roads, g Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway Inter- n <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EX STING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> O <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ................................................................... .......... <br /> , <br /> N _ <br /> 3 <br /> 0 <br /> s <br /> � Z <br /> O <br /> hi r <br /> C N S N c <br /> a N <br /> f <br /> - m <br /> Z ON. Datr <br /> o a ' S <br /> _ ' 3 <br /> 0 <br /> �=aq- rT <br /> ......... .........0'w-i..'t'o-r............... ........... ............ ....................... ... o <br /> Signature of Owner or Agent Date — <br /> x � <br /> m (�� <br /> Remarks ................................................................................................................................................................ ........ C W . <br /> m <br /> ....................................................................................................................................... . .......... ......................... ........ O- <br /> II <br /> Inspection Date ....................................... ...... ........... . .'. !.l.. ..... .. . .. ... .... :� u k, 8 W 8 "" rr <br /> Zoning Administra r ` :� 8 8 S <br /> �. . <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 he 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 he Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICEI AND APPROVED. <br />