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Burnett Count!yr Office of Zoning Administrator o 0 1 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 Q <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as f� <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 cD <br /> cD <br /> CL <br /> ��E ( 1WE K- T � i�P ................ ........................................................................... ° <br /> OWNlease punt) CONTRACTOR or SURVEYOR or AGENT a <br /> Nr� C <br /> ADDRESS .�............. .............. . .... <br /> ADDRESS JCDG �- <br /> ' ................... ............................................................................................ <br /> ADDRESS / ADDRESS y <br /> ................................................................................. <br /> PHON PHONE <br /> /10 <br /> .. <br /> PLUMB R WELL DRILLER <br /> ..Z... / .. -r.� . 3............................................................................................ <br /> ADDRESS ADDRESS 0 <br /> .. ........ `� �. -............................. ........... o 7t <br /> ° <br /> PHONE PHONE <br /> z y . <br /> DESCRIPTION 4. SanitaryFacilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .......... o <br /> New Building Type of Construction: No. Bedrooms CD <br /> Addition Se tic Tank Size Gals. r <br /> .................................................... <br /> Sanitary Size .............. ft. x .............. ft. <br /> Filling .....•.... Height............. Stories ............... 4a. Absorption Field-Ste: �j <br /> Moving Area Soil Type .........C! . C.�L."'?' —J� ' I <br /> ........................................... <br /> Grading Slope .......................................... <br /> ......... <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 .......... I <br /> Seepage Bed .......... <br /> ---------------------------------------------------------------------- Cn <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road xJ 00, : <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 i �• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o N' <br /> o c <br /> ------------------------------------------------- <br /> 5. Lot S�ze�'j ,r•� Fig. A. 6. Location: <br /> .(. ft. x ft. — /.4r Q U sq.ft. ............................................................................... c <br /> Q, <br /> �0 <br /> 0 moo. <br /> CD z � <br /> o <br /> m <br /> n <br /> m <br /> cnrT*icnooz <br /> CD 3 < fD c ID <br /> UlO H: H G n m <br /> Z 0 ° `D N <br /> oLn <br /> = � <br /> Ln _ <br /> N15 CD p <br /> Signature of Owner or Agent Da <br /> ................................................................................................................. „ m <br /> Remarks . ..................................... ... . co � <br /> CD <br /> ...�..re!!...D�,.w..... n..r m. IE�..... �.�.�u E f.....11.4..?-....3AI...h.r.7.7....................................................................... � <br /> v....... ................. m <br /> K <br /> �•j� ....�..`.'. ...... . ...:...... ............... :Oc► o 0 0 <br /> Inspection Date ✓ g � �� rn <br /> Zonis Admini rator o 0 0 o N <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 />