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Burnett County Office of Zoning Administrator u o 0 <br /> � 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 '< ~ <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation /Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a � <br /> . . . .. . �............ � ............. ............ .. . ✓...... .. ... . .G. .................... N <br /> OWNio <br /> (Plea e print) CONTR SURVEV0 or AG T o. A <br /> 3.. ....3.?... r.� .. . ..to ``..... �. ....... <br /> ADDRE ...+.... ..... ADDRESS ............ ........ ........ ./ <br /> e.. .... . .� /..5...... <br /> 'Al ..... . ................................. <br /> ADDR SS ......................................... <br /> ADDRESS <br /> . ................................................................................ <br /> PHONEPHONE ................................................... 11 <br /> i •i <br /> ........................................................................................... W <br /> PLUMRER ............................................................................................ R. <br /> WELL DRILLER <br /> O <br /> ................................................................ . . .. . .......................................................................................... <br /> .... ................ ... <br /> ADDRESS ADDRESS � <br /> ...... .................................................................................. ^. < ` <br /> n 0 <br /> PHONEPHONE....................................... ...........,........................... 0 <br /> DESCRIPTION 4. SanitaryFacilities: ° o ,°r. <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building ,..^ No. Bedrooms ... '�y5 -o <br /> Type of No. <br /> Addition �r f� rQ�• Septic Tank Size Gals. <br /> Sanitary Size ...a,.. ft. x .../� <br /> m <br /> N.. jf,,.T.... ft. .... o <br /> Filling/GredIng / 4a. Absorption �+ IM <br /> . ........ Height..,,/.�... Stories ............... ption Field Sit <br /> Moving Area Soil Type ...............-�'.4'n:. ..... :g i <br /> .......... ................................... r <br /> Mobile Home .......... Slope .......................................... Q <br /> Privy ,,, ,,,,,, 3. Use (describe exec 1 -family Perc. Rate ................................... <br /> k <br /> Well home,garage, motel, etc. Dry Well .......... , <br /> Subdivision ........., . Seepage Trench .......... .� <br /> ......... ........................................ . ,rte <br /> Camping Unit— Privy <br /> .......... ................................................... .DpIyA�e.LL O <br /> __ Seepage Bed �>7. ...... <br /> ___________________________________ t o .N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc_ should be sketched in Fig. A. Include road J///���• C3lY <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 �U <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING il( <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 5 5 <br /> 0 <br /> _____________-----_____________________________ <br /> 5. Lot Size: Fig. A. 6. Location: i <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> P <br /> N <br /> A <br /> N a p' <br /> o <br /> c <br /> 9 <br /> Z <br /> 0 <br /> 7J <br /> a <br /> m <br /> so mt <br /> <-o to <0 c' na <br /> to - <br /> g <br /> ......... .... ............... . . ......................... m <br /> a _ C <br /> Signature f O ner or A en Date C <br /> X <br /> Remarks �r <br /> ...C...::. <br /> . .. .....",..... . . ...................................... T rh <br /> ...........1 ...... ....... rz:r . ........... e _ <br /> ................................................................................................. <br /> ..............✓,// ' <br /> .............................................. . � <br /> Inspection Date //� � <br /> ' 1� �.GGUl, � f%1. ............ I oaouoam <br /> 1 <br /> Zoning Administr or ✓ g g g g g g y <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 he 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. <br />