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Burnett County" Office of Zoning Administrator C - - 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < ti -^ x� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD :Y F <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. aR' <br /> �+ Q <br /> .................. N h <br /> /...�.[.� i°. ?1..../.1.�.......�Ct? / ................. �?2�........ <br /> �..... � V � O <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT CD fD <br /> a CD <br /> !U <br /> ADDRESS ADDRESS � .� :� <br /> ........................ <br /> ................. "A' <br /> . . . <br /> ADDRESS AD... <br /> ............................................... ............................................................................... v <br /> PHONE PHONE <br /> .......................................................................PLUMBER WELL DRILLER <br /> 'N, <br /> ADDRESS ADDRESS CD <br /> o <br /> 0 < <br /> o <br /> PHONE PHONE z H r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> No. Bathrooms 0 <br /> 1. Work: 2. New Building Details """"" o � <br /> New Building .......... Type of Construction: No. Bedrooms L <br /> CD <br /> 0 ; <br /> Septic Tank Size Gals. <br /> Addition .......... , <br /> ................................................... <br /> Sanitary .......... Size .............. ft. x .............. ft. <br /> Filling ......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... o <br /> SlopeGrading .......................................... �+ <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 .......... <br /> �. <br /> Seepage Bed <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road o <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING y <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. b <br /> ---------------------------------- ------------ <br /> ----------------------- <br /> 5. Lot Size: Fig A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... A <br /> � O <br /> CD <br /> 0 <br /> Q i h <br /> o . <br /> r o <br /> 0 <br /> N <br /> ~ 'n IN <br /> CD <br /> \, 0 <br /> v <br /> 7 <br /> V CD <br /> D <br /> L I _ M cnr -0*cnc0z <br /> CD C SU ', 0 <br /> C CD <br /> m NO�..a< '+ CL <br /> C H H cc `2 m <br /> i <br /> J_ 1�C-,1 z <br /> .No CDp <br /> ............. ....e(.. 7..t 4a......... <br /> Signature of Owner or Agent Date Ul V <br /> `` P X <br /> ? r. <br /> RemarksJ ..... ..... �% °trtc. N <br /> a9.....................................................................v ......... <br /> � m <br /> to <br /> ........................................................................................................................................................................................ <br /> ......................................................................................................... . ....................... . .............................. <br /> Inspection Date ....................................... :../.. ....btr <br /> o 0 0 0 0 o m <br /> 0Zoning AdCJ a:�% 0 0 o cn <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 />