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Burnett County Office of Zoning Administrator a o 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 H µ <br /> N <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 cu <br /> j . ... <br /> ��/y..'�.�.'�-�../..:..�!�'Y................................................... ,�tz:�.::.-.:.......`�.....(/C/Q��.'..`.'r.ALJ............................ N O <br /> OWNE IR' please print) CON RACTOR or SURVEYOR or AGENT a <br /> , _ <br /> h9.5f ..a.....:. �...... .d y..................................................................... <br /> ADDR SS ADDRESS m <br /> ........................ <br /> ADDRESS r ADDRESS i \' <br /> ..C�/';�.......7.71). . ...}. ........................................ <br /> ............................................................................................ <br /> PHONE PHONE <br /> ........................................................................................... WEL. . . ..L..DR.....I. ....................................................................... (y <br /> PLUMBER LLE.... R <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ADDRESS n o <br /> ........................................................................................... . .. ................................................................................... <br /> PHONE PHONE.... .. Zr <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details o <br /> New Building ...... ... Type of Construction: No. Bedrooms .......... <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... i <br /> Sanitary .......... Size ft. x ft. " ••."• <br /> FillinglGrading .......... Height............. Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area ........................................... Soil Type .................................... <br /> o <br /> Mobile Home .......... Slope .......................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision � Seepage Trench .......... <br /> .......... .................................................... <br /> Camping Unit .......... Privy .......... <br /> .................................................... <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- <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- 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. o <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> j SU <br /> o <br /> I � s <br /> €c <br /> Z <br /> p <br /> i <br /> rJ <br /> N d N cm m <br /> C <br /> CD M <br /> Z <br /> o <br /> :j O <br /> '. p <br /> ........................................................................... .G`... ............................. o : C <br /> Signature of Owner or Agent Date <br /> X 70 <br /> Remarks ......................................................................................................................................................................... m .k3 m <br /> v <br /> w 11 <br /> ....................................................................................................... .. ........................................................ ut T <br /> ,�tQ .....1............... <br /> Inspection Date ....................................... .> ...r......7......����„ur r. . .. m <br /> Zoning Administ ator " J R 8 8 0 0 0 0 co <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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />