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Burnett County Office of Zoning Administrator d T o
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3
<br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as — �
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<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e .0
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. n
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<br /> ......................... .............�.E k�r............................................................
<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT O. »
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<br /> ADDRESS ADDRESS
<br /> ADD��RES��S((�� ADDRESS 9J
<br /> PHONEWI.4V. ......1.I. ..................................................... .PHONE..
<br /> PHO........................................................ ...........................
<br /> ........................................................................................... ...... .....................................................................................
<br /> PLUMBER
<br /> WELL DRILLER :U
<br /> O................................................................................ "ID,
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<br /> ........... ..........................................................................................
<br /> ADDRESS ADDRESS
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<br /> PHONE................................................................................ . .......................................................................................... �Z o „ '
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<br /> DESCRIPTION 4. Sanitary Facilities: °o
<br /> 1. Work: No. Bathrooms .......... -O
<br /> 2. New Building Details ` o
<br /> New BuildingNo. Bedrooms .......... a
<br /> Type of Cons ction:
<br /> Addition ,I`ADOO�,,,,��t d „_....,,, Septic Tank Size Gals. .......... ;
<br /> Sanitaryi
<br /> .......... Size .,rR.4.... ft. x ...e7. ... ft.
<br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site:
<br /> Moving .......... Area . . . . .. Soil Type .................................... �
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<br /> Mobile Home .......... Slope .................................... ..... o
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<br /> PrivPerc. Rate ...................................
<br /> Privy .......... 3. Use (describe exactly, 1 -family
<br /> Well Dry Well.......... home,garage, motel, etc.) .......... 9.1 '
<br /> Subdivision .......... .................................................... Seepage Trench ..........
<br /> Camping Unit ,,,,,,,,,, Privy ..........
<br /> ....................................................
<br /> Seepage Bed ......... .Z`
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<br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-, should be sketched In Fig. A. Include road c
<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 EXISTING Q% vl
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<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I a' ,f^
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<br /> 5. Lot Size: Fig. A. 6. Location: l`
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<br /> ................ ft. x .............. ft. — ............................... sq. ft. ..............................................................................,
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<br /> Sign or caner or Agent Date
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<br /> Remarks ..Seu. ... ./1...3f/o...p............................................................................................................. X m
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<br /> Inspection Date ....................................... ��.%? ? I° u u o N o a m
<br /> Zoningmi strator / $ $ $ $ $ $ N
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<br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faclhties
<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 be 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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