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5r C'l �: <br /> urnett County Office of Zoning Administrator W CD 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <br /> TO THE#ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <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 /> oc <br /> y rF G <br /> m <br /> OWN (please print) TRA OR or SUR EYOR or AGENT CD <br /> ........................................ o , <br /> ADDRESS AD RESS <br /> v <br /> ,..��.�...... .y �a................................ <br /> ADDRESS ADDRESS <br /> .. .. ................................... ............. .............. :� <br /> PHONE PH..ONE....... ........ ........ qp <br /> PLUMBER WELL DRILLER <br /> ................. ...... .... ........... 0 <br /> ADDRESS A...DDRES.. S n o <br /> C* < <br /> ............ o <br /> .... ' <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o �• <br /> New Building .......... Type of Construction: No. Bedrooms -CD <br /> 0 <br /> Addition „•.,•,•„ Septic Tank Size Gals. .......... <br /> ................................................... <br /> Sanitary .......... Size .............. ft.x .............. ft. .......... <br /> Filling Height............. Stories ............... 4a. Absorption Field Site: i <br /> Area Soil Type .................................... o <br /> Moving ........................................... <br /> Grading .......... Slope .......................................... �+ <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage,motel,etc.) Dry Well <br /> Well Seepage Trench .......... <br /> Subdivision ..!�.. :.:...... Privy .......... <br /> ........ . ...... <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- 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. T. <br /> 0' <br /> ------------------------------------------------------------------ <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft.— ............................... sq.ft. ............................................................................... <br /> � SCn <br /> ` N <br /> r\ 0 7 <br /> r-F <br /> I I <br /> C o <br /> n� <br /> Lo <br /> CD <br /> I„U rv�cncoz <br /> c CD <br /> ^` H' •G � `e rtl <br /> Z C <br /> o. <br /> a O o <br /> m <br /> CD <br /> `• <br /> Signature of Owner or Agent Date 0 C <br /> X <br /> Remarks ........................................................................................................................................................................ - ? C <br /> CD <br /> ....... ................. <br /> ...................................................................................................... ............. ............................................. T <br /> 000CD0Lnrl <br /> Inspection Date .7"""""""""""' :q� ° o 0 0 0 0 o m <br /> g <br /> Zonin A ministAor o: 1° 0000000 <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. <br />