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Burnett County , Office of Zoning Administrator a) (D 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . , 3 �- <br /> o <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 (D cCD <br /> ;GJ <br /> Drdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a <br /> W• �. ........�!.. ..^..¢........... . .. .. ... .................... . . Y.... .. .... . .............. _ <br /> 0 <br /> DWNE (please print) CONTRACTO UR YOR or AGENT CD <br /> �a� .... 10... .a...... -. . . ., ,� -...... ` <br /> ADC7RESo ADDRESS <br /> 1,> .0........�_W-.4 ....................... .. s.... ................................ <br /> ADDRESS ADDRESS (� <br /> PHONE PHONE <br /> ........................................................................................... .......................................................................................... <br /> PLUMB �� �1 WELL DRILLER <br /> /....d ..... .1...!...Y .......... .:�........ ............................................................................................ <br /> ADD ADDRESS �/' n LD <br /> v � <br /> �?— f. .7�s� �i . ...........�......................... 7............................................................................................ h. <br /> PHONE PHONE Z y r <br /> DESCRIPTION 4. Sanitary Facilities: ° 20 <br /> o ° <br /> 1. Work: No. Bathrooms ""2. New Building Details " 0 <br /> New Building j Type of Construction: No. Bedrooms ... m <br /> Addition „•,,,,,•,•.•,•••. ••... Septic Tank Size Gals. <br /> Sanitary Size .............. ft. x .............. ft. <br /> Filling ••.•.•.... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .................... ......... o <br /> ...... <br /> GradingSlope .......................................... <br /> Mobile Home .•........ 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench .......... <br /> .......... .................................................... <br /> Subdivision Privy .......... r <br /> .................................................... Seepage Bed .......... r <br /> ---------------------------------------------------------------------- <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig A. Include road a ' <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- fl <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 /> Cn <br /> CD <br /> o' <br /> y' <br /> r-F <br /> o o <br /> CD <br /> Z v <br /> d <br /> CD <br /> y <br /> :d cnry cncoz� <br /> < ID CD c CD <br /> m <br /> 6N. c < L m <br /> o z o' CD �D 70 <br /> rn <br /> M <br /> �- � <br /> Signs of�C��ner or gent Date ` ; <br /> X i 70 <br /> Remarks . .�...��:..����..................................................................................�(................................... � m <br /> CD <br /> v <br /> ....... ... ..�C'. ....�... ... ............................................. .................. .. ...... ..may........../•....................... <br /> -.� �GL �4� 0 0 0 � L m <br /> Inspection Date ..1 ...... .............. /� • O• m <br /> g .. .... ........ .......................... <br /> Zonin Adminis ator 000 0 0 Cn <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary faci ities <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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />