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Burnett County Office of Zoning Administrator fC c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements o the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all ther applicable County Ordinances and the laws and 3 `a <br /> regulati ns of the St of Wis in. — <br /> ......... ... �Y..J•��./.� ......................... ............ !.W .... Y'..I...Y../`J'. .. . ..... ........................... ....... <br /> OWN�yR�UI le pri tl Ia,� Ips CP�N(� CTOR otrr S* R6 V^O;R of A NT (y'� <br /> ADD.RESS� .{... ................. C <br /> .......... .... d i <br /> ADDRESS <br /> — <br /> i-- ' <br /> . . ................................ .............. ............... .... <br /> ....... . ....... <br /> ADDRESS ADDRESS s-- <br /> ........................................................................................... ...1-0"N-.................. <br /> ................ <br /> ........... <br /> ............... <br /> ............... ....... u �v <br /> PHONE . ............................................................................ PHONE <br /> . ..... . . ....... . .............................................................. ....... <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... <br /> ADDRESS ADDRESS ' <br /> c 0 <br /> PHONE PHONE J ' <br /> Z � 1 <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New BuildingT No. Bedrooms <br /> .......... ype of Construction: " """' 'R <br /> Addition ................................................ Septic Tank Size Gals. .. ....... <br /> .......... <br /> Sanitary .......... Size .............. ft. x .............. ft. .. ....... <br /> Filling/Grading ,,,,,,,,_. Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ............................ ....... ' i r <br /> Mobile HomeSlope .................................. . ° <br /> Privy ,,........ 3. Use (describe exact ly,'1 •family Perc. Rate ................................... <br /> Well ,,,\ ,,; home,garage, motel,etc.) Dry Well .......... ° <br /> Subdivision . .J�.. Seepage Trench z i <br /> r...\ p ^^: <br /> Camping Unit .......... .................................................... Privy .......... !�� v-f <br /> .................................................... Seepage Bed .......... <br /> -------------------- -- l <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi 3. A. _ <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ': :V o <br /> __________________________________ ___ __ —K1d J. <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. <br /> a 'elq <br /> T <br /> � <br /> 0 <br /> � <br /> 0 <br /> € I M <br /> d <br /> m <br /> m n a m a n y <br /> 9 < d C <br /> y `f N p b (O <br /> Z ? a <br /> O <br /> rna ; y <br /> O <br /> = c <br /> o <br /> ........................................................................... A <br /> ....................... x rn <br /> Signature of Owner or Agent Date ' C <br /> 8 : <br /> Remarks v, <br /> N <br /> ......................................................................................................... .. ......................1.. ... . .. ........ ....... .. O <br /> ... . <br /> Inspection Date ....................................... ... . . . . . ....�?.... e .. . (Nl, (�T N O O (NT m <br /> Zoning Administrato 8 8 8 8 8 8 to <br /> NOTE: A preliminary site inspection must be made and site app at granted on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> madewithout approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />