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Burnett County Office of Zoning Administrator c o 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. D
<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
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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 a \ `
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<br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a �^
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<br /> ADDRESS / ADDRESS
<br /> ADDRESS............................................................................ .ADDRESS............................................................................
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<br /> PHONE r PHONE
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<br /> PLUMBER WE LL DRI L L E R
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<br /> ADDRESS ADDRESS m Gl
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<br /> PHONE PHONE Z17
<br /> DESCRIPTION 4. Sanitary Facilities: ° o ° '
<br /> 1. Work: No. Bathrooms
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<br /> 2. New Building Details •••••••• o
<br /> New Building ,,,,X,. Type of•Construction: No. Bedrooms .... ..
<br /> Addition .............Jr�o'(�...ka.kq.!+9C..... Septic Tank Size Gals. /.Q.O...
<br /> Sanitary „•,X,,, Size ......z.B... ft. x ..,y .. ft. ���
<br /> Fillingt Grading .,,.,,,,,. Height......S..... Stories ...I........... 4a. Absorption Field Site:
<br /> Moving .......... Area .........lSQ.Q....................... Soil Type ...........S o n . •m
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<br /> Mobile Home
<br /> Slope ................... ..�r�.......... ..
<br /> .......... C
<br /> Privy ,.,,,,..,, 3. Use (describe exactly, 1 -family Perc. Rate ..................k .............. I
<br /> Well home,garage, motel, etc.) Dry Well .......... 741
<br /> Subdivision —�.......... `W
<br /> Seepage Trench ..........
<br /> .................................................... Priv
<br /> Camping Unit .......... Y ..........
<br /> .................................................... Seepage Bed 20X, t
<br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include 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
<br /> section, show 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. O i� p
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<br /> 5. Lot Size: Fig. A. 6. Location: C SU/jV�. 1
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<br /> ....C7.:. 1.6. ft. x ..sZ.l.�.. ft. — ..11..,�..�.y 0....... sq.ft. .................... ......................... .... ................... :OV
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<br /> e of Owner or Agent Date
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<br /> Remarks ......................................................................................................................................................................... T m
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<br /> Inspection Date ....................................... ..�hzl.9.../..:... ;�.GiiJJLG ;O?,rJ.. ................. xn o a o rn oU
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<br /> Zoning AdministratorIV,' 8 8 ,8 8
<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.
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