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<br /> Burnett County Office of Zoning Administrator d T --I 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 a
<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as N .�
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e
<br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 A ... ............................................................ ......... . . . . . . . ...... .................................
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<br /> OWNER'
<br /> � C R�r SU RVEVOR r AGENT a
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<br /> T�/.................,.......rlf/.......S..Y.. ..3......................... d
<br /> ADDRESS
<br /> ADDRESS............................................................................
<br /> ADDRESS ADDRESS
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<br /> PHONE................................................................................ .PHONE................................................................................ .t�F
<br /> . ................................................................................... 'W- .......D..RILLER............................................................................... "\
<br /> PLUMBER WELL
<br /> ........................................................................................... .AD......D'R"'E'S"S'
<br /> .RES.. .... ..............................................................................
<br /> ADDRESS S
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<br /> ........................................................................................... .PHONE-H-0-..................................................................................... o' .:
<br /> PHONE Z H �
<br /> DESCRIPTION 4. Sanitary Facilities: ° o
<br /> 1. Work: No. Bathrooms .........I o v
<br /> 2. New Building Details 0 W
<br /> New Building .......... Type of Construction: No. Bedrooms .......... g
<br /> Addition ,,,,,,,,,, Septic Tank Size Gals. .......... F '•
<br /> ....................................................
<br /> Sanitary .......... Size .............. ft. x .............. ft. .......... M i
<br /> Field Site:
<br /> FillinglGrading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption �
<br /> Moving .......... Area ........................................... Soil Type .................................... o
<br /> Mobile Home .......... Slope ..........................................
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<br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ...................................
<br /> Well home,garage, motel,etc.) Dry Well .......... i
<br /> Subdivision ,(/„ Seepage Trench .......... b
<br /> ....................................................
<br /> Camping Unit _,,,,,,,,, Privy .......... o
<br /> .................................................... Seepage Bed
<br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include roach
<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
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 0
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<br /> 5. Lot Size: Fig. A. 6. Location:
<br /> ................ ft. x .............. ft. — ............................... sq. ft. ...............................................................................
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<br /> Signature of Owner or Agent Date
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<br /> Remarks ......................................................................................................................................................................... m v
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<br /> Inspection Date ....................................... .. ... .......................... $:Ot U U o 8 '0 8 n'I
<br /> --Zoning �• inistratoi " 0 8 8 8 8 8 8 tmn
<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 lie made without approval of the Zoning Administrator.
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
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