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Burnett County Office of Zoning Administrator M o I_
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT
<br /> 10 THE 70NING ADMINISTRATOR The undersinned hereby makes application for a Permit for the work described and located as m
<br /> shown herein. The undersigned agrees that all work shall be done n accordance with the requirements of the Burnett County Land Use
<br /> Ordinance, Sanitation Codde, and with all other applicable County Ordinances and the laws and regulations of the State of WWisconsin. 3 a 1
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<br /> OW RIP se print)
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<br /> / r-C.� ��..�...................... .0 CONTRACTOR or SURVEYOR or AG T/rr.!�.:�.f.`'l!........ O
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<br /> PHONE PHONE
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<br /> PLUMBER WELL DRILLER
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<br /> DESCRIPTION 4. Sanitary Facilities: �. ° o °
<br /> 1. Work: 2. New Building Details No. Bathrooms .......... o ?
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<br /> ✓ No. Bedrooms L
<br /> New Building .......... Typeyy,,�� C99 nstru on: r r' : m
<br /> Addition ,,.,,.,(�Q:J„P,,,,, li,,..,.,.,... Septic Tank Size Gals. .......... `
<br /> Sanitary .......... Size .......Yui ft. x ......�. .Q ft. .......... .i ! i
<br /> Absorption Field Site: q.”
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<br /> Filling ,,,,,,,,,, Height............. Stories ............... 4a. Absor P
<br /> Moving .......... Area ......................................... Soil Type ...........................I........ ITS
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<br /> Grading .......... Slope .......................................... .+
<br /> Mobile Home .......... 3. Use (describe exactly, 1 family
<br /> Pere. Rate ...................................
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<br /> Privy .......... home, a9 rage, motel, etc.) Dry Well .......... 1JJ
<br /> WellSeepage Trench ..........
<br /> .......... .... ...............................................1
<br /> Subdivision .....__. «Ysa.�.Q.:..f.':.Nv:.. � - /l o'er Privy .......... I E
<br /> Seepage Bed ..... .. w, �
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<br /> Locatlon of proposed nu<t rres aid rxisting st .retires, well sewage systems, roads, etc, should be sketched in Fig. A. Include road
<br /> setback, side and beck Vard oimenson and location and selhack from all bodies of water- If property is located at a highway inter- a
<br /> section, show rhe inter.-ring highways and the setbacks inquired along them and at Ure intersection- CLEARLY LABEL EXISTING I
<br /> STRUCTURES AND PROPOSED STRUC-IURFS AND ADDITIONS- d' —
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<br /> 5. Lo Size: qT / / ,� Fig. A. 6. Location:
<br /> _ .4?/2... ft. x 1a�.7....... ft. - .�. ..../l.r_ve r.. sq. t. ........\^.f..v��"......"
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<br /> / ' Om! .../ z/....................ure o caner or Agent Date
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<br /> Remarks ......,.r............./.......................././....,....../.I..................,...._.,._.../.................... m
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<br /> . ... .. TG` . .1! r R'�utiC.Xc..� /C- k �!f.. /G �.� 4--•c �s:... ...... ........... . ..... ..... 69 —
<br /> .... ..��f�tu..�Z. -C.<.t_.(% , . ./32�z , ...�te�ry— . «..:�a.)( Na
<br /> rtspection Date ...... 9✓t V J'/ . 0 0 0 0 (0
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<br /> ``,i �LVnILt.V�I p �m /-_#� � Zonin dministrator 00
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<br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faClIII
<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 he Issued. Do not purchase or install a septic tank, rlo 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. Chanyes 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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