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Burnett County Office of Zoning Administrator 0 0 <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 m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> o <br /> H <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT............................... a — <br /> 7... ../-u :.c........i/..v...................................... — <br /> ADgRESS ADDRESS <br /> 1 ..CfniS ....t..�L1r.S....................5�/� 03 <br /> ...................... ............................................................................................ [ <br /> ADDRESS 7 ADDRESS : <br /> Po ' 7�y `.d0 > ................................................................................. �. <br /> ONE PHONE <br /> ........ .............. .....................P:......................................... ........................................................... .. ............................. <br /> PLUMBER ' ( WELL DRILLER i <br /> ADDHES ADDRESS : ;ri <br /> y m L7 <br /> AV 0 <br /> PHONE PHONE Z D m :� <br /> DESCRIPTION Sanitary Facilities: ° o <br /> . o <br /> 1. Work: 2. New Building Details No. Bathrooms � � o rt <br /> New Building ype of Construction: No. Bedrooms �S ;(� <br /> :.. <br /> �f T <br /> Addition Septic Tank Size Gals. .... ..... <br /> Sanitary <br /> .... .... Size .t........... ft. x Stories <br /> ........ ft. <br /> Filling/Grading ,,.,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................................... ., o <br /> Mobile Home Slope ............ ., tt ,, `` ,i �* <br /> Fare. Rate ........7.-..`�.. ..Y........ <br /> Privy 3. U (describe exactly�yinil� <br /> Well garage, motel, etc.) Dry Well .......... -ty <br /> Subdivision ,,,.,.,,,. Seepage Trench .......... w <br /> .................................................... <br /> Camping Unit .......... Privy <br /> .................................................... ....... .. <br /> r <br /> - <br /> Seepage Bed N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, eta, should be sketched in Fig. A. Inc',ude road <br /> setback, side and back yard dirnenslon and location and setback from all bodies of water. If property is located at a highway inter a <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. 0' <br /> _______---________________________________________________________.______ <br /> 5. o Ize: _ Fig. A. 6. Location: r o <br /> ..700 ft. x .���... ft. . .................... .......... sq.ft. ......... .......... <br /> ti <br /> N � a. <br /> 0 <br /> o <br /> See ms n o <br /> T <br /> O <br /> M <br /> a <br /> o <br /> C d r d c m <br /> ZO O m D o T <br /> O 7 ' ¢ro <br /> faa <br /> ...................................."'g'e'Al <br /> ...................................... c p <br /> Signature of Owner or Agent Date <br /> X <br /> Remarks ......................................................................................................................................................................... .n m <br /> v <br /> ve <br /> ....................................................................................................................................................................................... — <br /> .......................................................................................................... .........................�.I�..f.................... .. <br /> yQ��'; <br /> En <br /> Inspection Date ....................................... ..(/ ... ....Y".C. .. c. <br /> . .. ............ ` b o 0 o m <br /> Zoning Admi � trator�� g: 0 0 00 o rn <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 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 Adrduostratoi- <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />