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Burnett County Office of Zoning Administrator --I 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 oc-, <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a Q <br /> �/-2u pt.. iQ <br /> ........................................................................................... c m O <br /> OWNER plea per pLL CONTRACTOR or SURVEYOR or AGENT m <br /> a <br /> ADDRESS <br /> ADDRESS ^ <br /> ADDRESS . . ...................................................................................... <br /> 1 <br /> ADD.. .. RESS <br /> ............................... ............................................................... ..... � <br /> PH ............................................................................................ <br /> x .................................... PHONE <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... <br /> ADDRESS . ...... . . .............................................................................. O o <br /> ADDRESS 0 <br /> �) <br /> PHONE PHONE N <br /> DESCRIPTION 4. Sanitary Facilities: ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms v <br /> New Building No. Bedrooms .......... L Pr <br /> ...x... Type o onstruction: m I <br /> Addition .......... ^a-^^;'•� Septic Tank Size Gals. .......... YT <br /> ............ ............ ....................... .. .`t 1 <br /> Sanitary .., Size Ae—.U�...... ft. x .....lP.�.. ft. .......... <br /> Finings Grading „........ Height.al..8..... Stories ...... 4a. Absorption Field Site: ' 7 <br /> Moving ... ...... Area . ............... Soil Type ........ <br /> .. .. <br /> Mobile Home .......... Slope ............ . .. .... ° ;r( <br /> ....... ..... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ..... .. ......................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision .......... {ala Seepage Trench (,s <br /> S p...... .. .5..'�.. .......... -I <br /> Camping Unit ,,,:,.„., Privy .......... <br /> ............ Seepage Bed .......... <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Flg. A. Include road i <br /> setback, side and back Yard dimension and location and setback from all bodies of water. If property Is located at a highway Inter a C.• <br /> section, show the intersectirg highways and the setbacks required along them and at the intersection_ CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0 <br /> 5. Lot Size: Fig. A. 6. Location: d <br /> ft. x .............. ft. - ............................... sq. ft. .................................................................._........... i <br /> n <br /> Orr <br /> IN o <br /> O � <br /> Imo' O n� <br /> s <br /> I / <br /> z Z :Cl,\Tf` <br /> .f� o <br /> re <br /> Mo r m Z <br /> n Q < o o m <br /> N C W W <br /> o m <br /> Z oo' . Dn <br /> o <br /> m <br /> .. ..v.. .......... ... .. '9en'............................... ....... Dat ..�.... �o <br /> Si nature of Owner o ent <br /> Remarks ..................... .. ......................... ... .................. . ........................................................................................... x M <br /> 5�........ � .Apar.. . . L....D/ ................................................................ <br /> till <br /> ....................q............................................................................. .... ............ . ...................... <br /> Inspection Date /:'..�.:..'..7................... <br /> . ........ ... ............. ............ ,uNi u o o <br /> Zonin dministrator $ $ $ $ opp0 iNN�-�/ <br /> OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faces <br /> ire construction can begin. In the case of sewerage disposal systems, a copy of the percolation test trust be attached to <br /> oplication before a permit will be issued. Do riot purchase or install a septic tank, do any plumbing or start any build <br /> II a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed herr <br /> nund to exist. Changes in plans or specifications shall not fie made without approval of the Zoning Administrator_ <br /> -R SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />