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Burnett County Y Office of Zoning Administrator �o z <br /> 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT B <br /> TO THE ZONSING,ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H o-^ <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,ir-r-VN <br /> Sanitation Code, and withh,all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a Ni <br /> F- <br /> p! c /) JO n N � .0 o <br /> OWNER (ple se pr ..., CONTRACTOR or SURVEYOR or AGENT csa m <br /> LIO SR-er WiS( - Q <br /> ADDRESS ADDRESS °; 4 <br /> CD <br /> ADDRESS ADDRESS t `N 4 -s <br /> P E ` NI\ ` <br /> vJPHONE <br /> -‘,9 <br /> PLUMBER WELL DRILLER <br /> ADDRESS N P. ' 5 <br /> ADDRESS <br /> oo r‘ <br /> PHONE PHONE r` <br /> DESCRIPTION 4. Sanitary Facilities: /2. New o o o ,� <br /> 1. Work :Building Details <br /> No. Bathrooms 7 <br /> New Building Type of Construct No. Bedrooms -00 7 <br /> Addition ..,,,1'l S/ /rt Septic Tank Size Gals. ^ 1 <br /> Sanitary G <br /> ..�.... Size ft. x ft. J... <br /> � <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type Z. r- <br /> Grading Slope ° <br /> Pt Mobile Home 3. Use (describe exactl , 1 -fami Perc. Rate <br /> Privy home,garage, motel, etc. Dry Well <br /> Well Seepage Trench <br /> Subdivision Privy • 0 <br /> Seepage Bed /4 )(•• • <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road ? o..N <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- o <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. <br /> F.:— <br /> 0 <br /> 5. Lig Size: / Fig. A. C <br /> O e ft. x / c ft. — sq. ft. <br /> i ° <br /> r+ <br /> 4--- N <br /> o o <br /> o <br /> ,, , c <br /> r- r_, <br /> c6 0" _ 0 <br /> , , N <br /> ... <br /> F))s <br /> C. <br /> JO cr- 7*� <br /> . r,) a =a.< �o d -. m <br /> _ 1 <br /> ~ b H H on xj <br /> OZ oo•m g <br /> �= <br /> • ol -I <br /> N <br /> NI 8 D <br /> 'n ‘ � s' <br /> �6Tc)- c <br /> 0 <br /> Sign ture of Ow er or Agent Date ,-« jp <br /> „ x tA m <br /> Remarks C Ir p <br /> f <br /> C � • :c <br /> i ''- ' 03 T <br /> Inspection Date , � ezaL/i'ey✓ 0000- m <br /> Zoning Administrator o o 0 0 o N <br /> TOTE: A preliminary site inspection must he made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> tis application before a permit will he issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ig until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> ith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />