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Burnett County Office of Zoning AdministratorCDoo <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> n� <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br /> ;hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Jrdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a qp <br /> • a <br /> �t1'.I.1.l:ti ...C,,.... rr► ��' � ............ .............�S.c�-f........ ... . .. y o <br /> ... . . . ...................................... <br /> JWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> '�. . . S.P.�'41:0.G ........�IDC�. ., �.......... ........................................................................... Q �- <br /> 4DDRESS ADDRESS >f <br /> PA ..f s............►��........................................ ........................................................................... <br /> I — ADDRESS C r <br /> . . -.--...' ..5 ...... �. . ......... <br /> 'HONE PHONE <br /> 'LUMBER WELL DRILLER <br /> v <br /> 4DDRESS ADDRESS <br /> CD <br /> 0 < <br /> ............:........................................................... �' o <br /> 'HONE PHONE Z �r <br /> DESCRIPTION 4. Sanitary Facilities: O ° 0 <br /> 1. Work: No. Bathrooms -0 r <br /> 2. New Building Details ......... ,r <br /> New Building Type of Construction: No. Bedrooms <br /> o <br /> CD Pt <br /> Addition (tf�YYj Septic Tank Size Gals. .......... <br /> Sanitary .......... Size ....xz ft. x .....II Q.. ft. .......... <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... <br /> Grading .......... Slope .......................................... .� <br /> o <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) Dry Well <br /> Well ......... • Seepage Trench .......... <br /> V ................. <br /> Subdivision Privy 6 <br /> Y <br /> Seepage Bed ...... <br /> ---------------------------------------------------------------------- 1�7` N :b <br /> _ocation of proposed structures and existing structures,well,sewage systems,roads,etc., should be sketched in Fig. A. Include road <br /> etback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- � <br /> ection, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> iTRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -------------------- <br /> i. Lot Size: Fig. A. 6. Location- <br /> ..... <br /> /� ,, <br /> d..... ft. x .�.Yo... ft. — ....1�. >............ sq.ft. ..Sv....0. ..Na-...Q ..G,ej VI1....[.Gl�....�. <br /> of s&Zl 3�/� — �'191,E <br /> 7U o <br /> W <br /> oCD <br /> Z <br /> © �o <br /> c r Cf)co <br /> GCD CD <br /> �, Naas <br /> m <br /> o ° <br /> CD <br /> cn cn � <br /> m <br /> h� .. .. ..... ..... ...... /.. . ... p <br /> _ : . ; . . . <br /> ignature of Owner or Agent �te .�� C <br /> X c 70 <br /> lemarks m m <br /> C 0 <br /> ...................................................................................................................................................................................... to <br /> .......................................................................................................... I' <br /> ispection Date ....................................... .. ... . o 0 o T <br /> � O.,cNri m <br /> Zoning Administ or ?`I�: 0 0 0 cmi� <br /> JTE: A preliminary site inspection must be 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 be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />