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Burnett Call Office of Zoning Administrator � 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. = O <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located 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 . o� <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> n <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT d <br /> ,.,..>v..b..�T.r........ .................................................................................... . <br /> ADDRESS ADDRESS $ <br /> ............................................................................. .............................................................................. T <br /> ADDRESS ADDRESS iN <br /> PHO E PHONE Q <br /> ..... . . i. p.!fr �...r:. . .... .. . . .... . . .... . IV <br /> PLUMBER WELL DRILLER i.- <br /> ' <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS o 0 <br /> ............. o' <br /> ........................................................................................... . ............................................................................. ,» <br /> PHONE PHONE z N <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: 0 0 0 <br /> No. Bathrooms <br /> v <br /> 1. Work:. 2. New Building Details ""'" o :J <br /> No. Bedrooms """" <br /> ' <br /> New Building .......... <br /> Type of Construction: <br /> Addition Septic Tank Size Gals. .......... < <br /> Sanitary <br /> 7C.... Size .............. ft. x .............. ft. <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> SoilType .................................... r <br /> Moving .......... Area ........................................... o <br /> Slope .................................:�...... <br /> Grading .......... 4 (� <br /> ",7 <br /> Mobile Home ._....... 3. Use (describe exactlyPere. Rate .......... <br /> , 7 -family "' ' �"' it " � <br /> Privy .......... home,garage, motel, etc.) Dry Well <br /> Seepage Trench <br /> Well .. <br /> .......... i <br /> Subdivision Privy <br /> .......... .................................................... <br /> Seepage Bed a.pV.... — � :� � ;c <br /> ._________ _____ N <br /> Location, of proposed structures and exwsbng strictures, well, sewage systems, roads, eta, should be sketched In Fig. A- Include road :� � <br /> tback, side and back yard dimensirn and 10(atlOn and setback from all bndles of water. If propat a highway Inter-erty Is located �J a <br /> se � <br /> section, show the intersecting highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING <br /> r 0 <br /> STRUCTURES AND PHOPOSED STRUCTURES AND ADDITIONS. o p� <br /> _..___-----__.._---_._----___------------------- — --_--_—__--_—_ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x ........... ft. . ............................... sq.ft. ............................................................................... P ' 7 t <br /> V <br /> O 01 <br /> n <br /> G <br /> 0 O' <br /> o � <br /> O " V <br /> 0 <br /> t� Z <br /> Li <br /> 7a vtr v � (nW Z\ <br /> m <br /> as an m <br /> Z o o' <br /> 0 _ c <br /> laer c <br /> en i <br /> N <br /> foo <br /> ........ ....... .................................... .7.. �.5- : ......... � p <br /> Signature of Owner or ,gent Date�^ / X <br /> Remarks (:/ (� ....:�. *Z. ,`-�.. ' T i O <br /> : <br /> ............. ........................................... ............................................................................................................... <br /> 6 <br /> ..........401 /ems :r ............................ . . ................. ,, <br /> an <br /> Inspection Date .... ........ '� t p o 0 0 0 o b m <br /> Zoningg Adm�r lC J di o 0 0 o y <br /> NOTE: A preliminary site inspection most 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 most 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 he revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes In plans or specificcitlons shall not Ire made without approval of the Zoning Administrator . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />