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<br /> Burnett County Office of Zoning Administrator H z
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<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT .
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<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as --‘ — ,' ..<
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<br /> ;hoyvn herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use -'9,
<br /> Drdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a
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<br /> DWNER (please printCONTRACTOR or SURVEYOR or AGENT CS Nst CD
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<br /> - ADDRESS A7/0
<br /> ADDRESS / ADDRESS
<br /> PAIDINE PHONE IC)
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<br /> Pc6/01)
<br /> L MBER WELL DRILLER
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<br /> ADDRESS ADDRESS c-73 0 10
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<br /> PHONE PHONE .
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<br /> DESCRIPTION 4. Sanitary Facilities: i)A• . 5 9--
<br /> 1. Work: 2. New Building Details No. Bathrooms -o i___.
<br /> No. Bedrooms
<br /> New Building Type of construttion: co
<br /> Addition x4- (,...,)(:),/ a_ Septic Tank Size Gals. -,
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<br /> Sanitary Size . b,.5-' ft. x PO ft.
<br /> Filling/Grading Height Stories 4a. Absorption Field Site: iI) .4.
<br /> Moving Area Soil Type \--- r
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<br /> Mobile Home Slope ,-
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<br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate ,-
<br /> Well home,garage, motel, etc.) . Dry Well 1--- --.
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<br /> Subdivision 2.0 C/O-S-C )5 C tell Seepage Trench :- )
<br /> Camping Unit eiZG;- — C.-/c- 11 'e'd Privy _..-
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<br /> "0/ 414 Seepage Bed -
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<br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. Include road • co-
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 1 0-
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<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING
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<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 3'
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<br /> 5. Lot Size: 00 Fig. A. 6. Location:
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<br /> /0 0 ft. x .,30 6 ft. — 30, C sq.ft.
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<br /> ignature of Owne r Agent if . ate o: C
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<br /> Remarks, A e t,47-ei . ,, PZA a..." mrr
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<br /> Inspection Date 9a.„..., /9 7.17;1„0 \ . 1
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<br /> Zoning Admi istrator et-J
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<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 he 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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