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Burnett County Office of Zoning Administrator W CD o 0 <br /> APPLICATION -FOR SANITARY — LAND USE — BUILDING PERMIT . . <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H V <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m eI CD <br /> :v <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0- <br /> ....................................... ............................................................................................ <br /> OWN <br /> //ER (please print) T CONTRACTOR or SURVEYOR or AGENT a CD <br /> CD <br /> ...7.. E. ............. ...... ✓!................................................. ......................................................................................... <br /> ADDRRESS ADDRESS CD <br /> A .......................... <br /> ADDRESS DDRESS ��..� . <br /> ..................................................... ................ ............................................................................................ <br /> ...................... : <br /> PHONE PHONE <br /> x.............. ; <br /> PLUMBER WELL DRIzitLLER <br /> `�..�`- ....J. .X....l..?4::. <br /> AD ..... � Tl .. 1.. ADDRESS <br /> CD <br /> (tea 0 O< <br /> ... ': .................................................. ............................................................................................ z 0 <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 ° <br /> 1. Work: 2. New Building Details No. Bathrooms `� o <br /> New Building .......... Type of Construction: No. Bedrooms t 0 <br /> Addition .......... .................................................... Septic Tank Size Gals. .7..5.0 <br /> Sanitary *5 - <br /> Size .............. ft. x .............. ft. <br /> Filling .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area Soil Type .............. ....... ^` o <br /> ......................................... <br /> Grading Slope ..................... ................... N. 0 <br /> .......... <br /> Mobile Home 3. Use (describe exactly, 1 family Perc. Rate .............�................. <br /> Privy ... ...... home,garage, moteli,/ettc_.) Dry Well .......... <br /> Well ... �RI'��C ..T '��..(�f Seepage Trench <br /> Subdivision e.ovkyPrivy <br /> ------------ --------------------------- Seepage Bed--- --- _.--- <br /> N <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- 4 a : <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. 0' <br /> ---- ------------- JJ ; <br /> 5. Lot Size: Fig. A. 6. Location: ?Q�' <br /> 4nL..�... ft. x .l.d ... ft. - ....r i/.flf?�......... sq.ft. ...............�1ei�1i� ../QC)!9.J......................... I i cam_ 1 <br /> C�; •� cn <br /> 0 <br /> N i� 0 <br /> o :. <br /> -n <br /> 1l r " z <br /> 0 <br /> d <br /> � c r .100 Zz <br /> fDC• CD <br /> Q <br /> O y; C n m <br /> Z o 0 fD �' (D <br /> 0 0 : <br /> cn � <br /> 4 0o <br /> ........... .......... � p <br /> .�... .... ....... ................C . � : <br /> Signature of Owner Agent Date ° C <br /> X � <br /> Remarks /. : 7i` 7 m : mo <br /> �/ <br /> fl.% - ........ Zr . V) <br /> ...........� . ; ...... .._ 4........ ........................................................................................................................ <br /> .............. ..1 ,r..: . . ............................. <br /> fA <br /> Inspection Date - D�yr.�'� shin r� 0 0 0 0 o c`n m <br /> ....................................... . ...........................:.. . <br /> Zoning Admi K istrator/` 11 o 0 0 0 0 o to <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 />