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Burnett County Office of Zoning Administrator u 0 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3.
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<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 c
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<br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 d '
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<br /> 6WNU please print) CONTRACTOR or SURVEYOR or AGENT o.
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<br /> ADDRESS ADDRESS
<br /> C :S:T.E.... .... t........59 .9c73...... ............................................................................................
<br /> ADDRESS ADDRESS
<br /> 2.5:y..-.... 3 ..9..7.................................... ....................................................................................... .. .
<br /> PHONE PHONE ? Vii..
<br /> ........................................................................................... ............Rii-..........................................................................
<br /> PLUMBER WELL DRILLER � 1
<br /> X,
<br /> ........................................................................................... ............................................................................................ _.
<br /> ADDRESS ADDRESS m Ll
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<br /> ....... ....................................................................... n o
<br /> PHONE PHONE Z H e-
<br /> DESCRIPTION 4. Sanitary Facilities: pp/ d ° o °
<br /> 1. Work: 2. New Building Details No. Bathrooms ........,. o
<br /> New Building Type of GA nstruction: No. Bedrooms ..........
<br /> Addition ...(
<br /> ..............1J1��,G /1�, ,,,,,,,,,.,, ,,,,., Septic Tank Size Gals. ..........
<br /> Sanitary .......... Size .../d..... ft. x ......✓...Z. ft. ......
<br /> 4a. Absorption Field Site: .
<br /> Filling/Grading ,,,,,,,,,, Height....�..... Stories ....`"....... .� .
<br /> Soil Type .................... ^ .. tiJE
<br /> Moving .......... Area ......................................... fv ' , o
<br /> Mobile Home Slope .......................................... ;y
<br /> Y Perc. Rate ...................................
<br /> Privy
<br /> .......... 3. Use (describe exactly, 1 -family
<br /> Well .......... home,garage, motel, etc.) Dry Well .......... i�
<br /> Subdivision .......... .................................................... Seepage Trench .......... I :m
<br /> Camping Unit y '
<br /> Priv .......... I o
<br /> .......... ....................................................
<br /> Seepage Bed O '
<br /> y
<br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road ii, I ' Q
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter-p eN iZ a
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING �j ^� p,y < >
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o
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<br /> 5. Lot Size: , Fig. A. 6. Location:
<br /> ft. x .. PIR .. ft. — ..... � L'00 L7..+sq. ft. OO ..... . ...:Z............................................. i� E
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<br /> Signature of Owner gent Date X
<br /> Remarks ............... ........................
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<br /> / ...................... o o N r 1� m
<br /> Inspection Date ....................................... .... ............. ...., .................. p: �g
<br /> Zonin dministrator 8 8 S 8 to
<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 most 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 Adm inistrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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