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Burnett County Office of Zoning Administrator W 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and locatedas < <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 <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> �!J �Q a 0 <br /> OWNER (pleas r' CO RA TOR or SURVEYOR r AGENT M <br /> �J <br /> 7�/ . .....r�.... ......S..Y.Z?.3......................... d <br /> ADDRESS ADDRESS <br /> ........................... .84......... ......9 ........................................................... <br /> ADDRESS ADDRESS <br /> t <br /> PHONE................................................................................ .PHONE................................................................................ <br /> ........................................................................................... . . . ..................................................................................... <br /> PLUMBER WELL DRILLER <br /> O <br /> ........................................................................................... ............................................................................................ —. <br /> ADDRESS ADDRESS m M <br /> n O <br /> ........................................................................................... ............................................................................................ O ri <br /> PHONE PHONE Z • <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: �0 0 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o: o <br /> New Building Type of Construction: No. Bedrooms .........I s 'o W <br /> Septic Tank Size Gals. <br /> Addition .......... .................................................... Sep .......... <br /> Sanitary .......... Size ft. x ft. •""""' r' <br /> FIIlinglGrading ..,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: i E <br /> Moving .......... Area Soil Type .................................... i <br /> Mobile Home Slope .......................................... y <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well <br /> Well home,garage, motel, etc.) Dry """"" <br /> ........ <br /> Subdivision „ Seepage Trench c <br /> .................................................... i <br /> Camping Unit .......... o ' <br /> .................................................... Privy """""Seepage Bed <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include roadp,� 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-0•e 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. p <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> ya <br /> 0 0 <br /> F €?t 0 <br /> 0 <br /> /v !E z <br /> O : <br /> S m <br /> J <br /> m <br /> N -o N m Z <br /> t0i <br /> c M. m c a <br /> tOr I = n F <br /> m o y^ <br /> a < m <br /> Z <br /> a <br /> m <br /> • Fn —m 3 <br /> KA o y <br /> p <br /> /o?- � <br /> SET C <br /> ignature of Owner or Agent Date <br /> X <br /> Remarks ........................................................................................................................................................... m m <br /> m : <br /> FA <br /> ............................................................................................................ .. ............. ............................................ <br /> ........ U � oBo � m <br /> Inspection Date ....................................... ...... .................... .... ......... <br /> . .. e m <br /> Zoning inistratoi 0 8 8 8 8 8 8 N <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 />