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t•Ic:-77t <br /> Burnett Cot my Office of Zoning Administrator 0 CD o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N <br /> o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c : <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> T.. . �... ..... 2................. ....... ... .. N o <br /> OWNER ( lease rin m <br /> P P CONTRACTOR or SURVEYOR or AGENT CD <br /> ADDRESS ADDRESS r. INS <br /> 4t✓! ��-t� .j.. ,!'-......s:s.<.tr30.................... ......................................................................................... <br /> ADDRESS ADDRESS <br /> ........................................................................................... ......................................................................................... <br /> PHON PHONE <br /> . .......................................... <br /> PLU ER WELL DRILLER <br /> ..Vl <br /> w C <br /> ADDRESS ADDRESS <br /> o <br /> h 0 <br /> w <br /> PHONE PHONE z 0 <br /> DESCRIPTION 0 <br /> 4. Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms .......... 7 <br /> 2. New Building Details �. o i <br /> New BuildingT No. Bedrooms .......... U a <br /> Type of Construction: i � CD <br /> Addition „•„ Septic Tank Size Gals. <br /> Sanitary RW <br /> ..... Size .............. ft. x .............. ft. <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: ; <br /> Moving Area Soil Type .............A.^!f ........ o <br /> ....... ........................................... <br /> Grading Slope ................... .'/;6 <br /> Mobile Home Perc. Rate ................... ^ <br /> ...... 3. Use (describe exactly, 1 -family /� ........ J' <br /> PrivyDry Well <br /> home,garage,motel,etc.) ......••• O <br /> Well page Trench ` <br /> .......... ................................ <br /> Seepage . <br /> Subdivision .......... Privy <br /> .................................................... Seepage Bed <br /> ------------------------------------------------------------- <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- 4 Q� <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 /> 0 <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: 'jZtF _09S Fig. A. 6. Location: <br /> y� <br /> ft. x .............. ft. — ............................... sq.ft. C. J ...................... ! A.. .... <br /> }7IZ1U�47t� f�{Zl U� <br /> co <br /> r+ <br /> IV 0 <br /> 0 0 <br /> D <br /> V 3 <br /> �SJ� �� c o <br /> cc <br /> CD <br /> M cn r v c'n w z <br /> 0 M <br /> (D. N a fl-< _ ,�-rt• <br /> oy:H � m <br /> z o o fD " 70 <br /> o �. <br /> U� m <br /> ....... .. ..........l..o «--..... _ p <br /> 5ignat re of Owner o Agent Date C <br /> X <br /> Remarks ......................................................................................................................................................................... CD <br /> m <br /> ........................................................................................................................................................................................ <br /> .......................................................................................................... ............................................................................ :'� <br /> Inspection Date ....................................... ��ZG�. .. ............ .... \ <br /> o: -n <br /> , , , <br /> Zoning Admi istrator rU 0 0 0 0 0 0 0 <br /> TOTE: A preliminary site inspection must be 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 /> its application before a permit will be 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 /> fith 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 />