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Burnett County Office of Zoning Administrator d Z <br /> ° o <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 located as <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 n V <br /> �f N o <br /> ............... <br /> OW E9 (please pJl�, �j /` q CONTRACTOR or SURVEYOR di AGENT m <br /> ..Kf �. . <br /> I..I/ �e..r' "�1 �Z.u�..:/./.......................... ......................... n V <br /> ................................................................ u C <br /> A/DDRESSa ......... � ADDRESS <br /> G�........... . ..,.. �......:....................................... . .......................................................................................... s Via\ <br /> ADDRESS ADDRESS <br /> ........................................................................................... HONE <br /> PHONE P <br /> ........................................................................................... . . ..................................................................................... <br /> PLUMBER WELL DRILLER <br /> ADDRESS .AD.....DR.....ES................................................................................ <br /> S <br /> n o <br /> PHONE <br /> DESCRIPTION4. Sanitary Facilities: ° o <br /> i. Work: 2. New Building Details No. Bathrooms <br /> New Building No. Bedrooms ° :V <br /> .......... Type of Construction: Ti if <br /> m <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... < <br /> Sanitary Size ft. X ft. <br /> ......... .............. .............. <br /> Filling/Grading .........• Height............. Stories ............... 4a. Absorption Field Site: i E <br /> Moving .......... Area Soil Type .................................... <br /> ........................................... r <br /> Mobile Home .......... Slope .......................................... : �-. <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... `) <br /> Well ....,,,,,, home,garage, motel, etc.) Dry Well .......... f <br /> Subdivision .......... Seepage Trench .......... <br /> Camping Unit ,,,,,,,,,, Privy ,......... f j <br /> .................................................... <br /> Seepage Bed <br /> ------------ ----------------------------------- -------AInclude road <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. . _ ° <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Qa <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING T- <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. UK <br /> 0 <br /> ----------------------------- ------------ _ t <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq. ft. ............................................................................... <br /> N <br /> f�° 5'3 9y 9r k <br /> 0 <br /> [ ° <br /> Es <br /> ,4 <br /> z <br /> o <br /> m <br /> Vh <br /> r 9 0 so Z <br /> Z O p m D a m <br /> mas <br /> ✓yA,` S aGr.�......... 'i o C� <br /> Signature of Owner or Agent ' Date <br /> X 70 <br /> Remarks . . . . . <br /> ........................................................................................................................................................................................ <br /> ......................................................................................................... / . . . . . . <br /> Inspection Date /-. 'jatt ��! N m — N m <br /> ell Zoning Administrator '�� io $ g g o 0 o y <br /> 0 0 0 <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 lie 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 />