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Burnett County Office of Zoning Administrator c -o --I 0
<br /> co cl,APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT h'
<br /> ° 74.
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<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as v' -�
<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. 3 a `/�
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m. t ..
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<br /> to 11 �.r `Z -/ V A t,-/` l lv,,,t, L..J a
<br /> ADDRESS
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<br /> ADDRESS i ADDRESS
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<br /> PHONE PHONE N,
<br /> WELL DRILLER
<br /> PLUMBER , (*-,.�
<br /> ADDRESS ADDRESS ;' C)
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<br /> PHONE PHONE o .
<br /> DESCRIPTIONo o
<br /> 4. Sanitary Facilities: o
<br /> 1. Work: 2. New Building Details No. Bathrooms
<br /> New Building Type of Construction: No. Bedrooms A z
<br /> Addition ✓ Septic Tank Size Gals.
<br /> Sanitary Size 1ft. x as ft. t
<br /> Filling Height.-7 ' Stories 4a. Absorption Field Site: ry
<br /> Moving Area `—..(•7....;:.q,,,f.}.,�:,,,,,,,,, Soil Type ��! I-
<br /> Grading ! Slope °
<br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate (�
<br /> Privy home,garage, motel, etc.) Dry Well tl
<br /> Well lit1 tar i 6,X 1 f i K Seepage Trench S�
<br /> Subdivision rr�.y, /
<br /> � tl� Privy t
<br /> Seepage Bed r
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<br /> _ocation of proposed structures and existing structures, well,sewage systems, roads, etc., should be sketched in Fig. A. Include road is,� C
<br /> ;etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- I _o-
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<br /> ;ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING O
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. "-'
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<br /> i. Lot Size: Q,
<br /> Fig. A. 6. Location: r ,c
<br /> �,� ft. x . ft. - `�©/ Do 0 sq.ft. •
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<br /> ignature of Owner or Agent Date ..
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<br /> lemarks -n m
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<br /> ispection Date ;24-0,-,r-era ° oo000 (Nnm
<br /> ZoningAdminisrator .c,.i o00co0ofm/)
<br /> JTE: A preliminary site inspection must he made and site approval granted on all structures involving sanitary facilities
<br /> fore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to
<br /> is application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build-
<br /> g until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here-
<br /> th 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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