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Burnett County Office of Zoning Administratord Z
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d' 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 < m
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use OC
<br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a �
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<br /> ADDRESS ADDRESSas
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<br /> PLUMBER .WELL..DR
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<br /> ADDRESS .ADD.......R..ESS... ...................
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<br /> DESCRIPTION 4. Sanitary Facilities: ° o 0
<br /> 1. Work: 2. New Building Details No. Bathrooms
<br /> New BuildingNo. Bedrooms o
<br /> .... ..... Type of Construction: o-Z-
<br /> Addition .... ................... ..Oo .... .. Septic Tank Size Gals. 1..aA.d
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<br /> Sanitary .......... Size ....�.��.y ft. X ....../.4... ft.
<br /> Filling/Grading ,..,,,,,,, Height...l..7.... Stories ............... 4a. Absorption Field Site:
<br /> Moving .......... Area /1 nI''``,,,,,,,,,,,, Soil Type .................................... _ ..
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<br /> Mobile Home Slope .......................................... o
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<br /> Privy .......... 3. Use (describe exactly, 1 -family
<br /> Fare. Rate ...................................
<br /> Well .......... home,garage, motel, etc.) Dry Well ..........
<br /> Subdivision ,,,,,, SGQ Q C �� Seepage Trench .......... Cl '
<br /> ... ....... .N.......�Q.• 2............. _1
<br /> Camping Unit .......... rr .... . Privy .......... (7%-
<br /> 7% a��•\
<br /> ---- --------------------- .................. Seepage Bed ..........
<br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig. A. In road
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- ) on
<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.
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<br /> 5. Lot Size: Fig. A. 6. Location: l :_
<br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... a i E
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<br /> Signature of Own or Agent Date ° . C
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<br /> Inspection Date ....................................... °............. .9.............. .. ....................... . 10. u, u, o v, o u,
<br /> Zonin Admin rator 8 8 8 8 $ 0 vmi
<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 b"t 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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