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Burnett County Office of Zoning Administrator d - 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> 0 <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 1 c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ................................... ?.... l.............................. m o <br /> OWNER (please print) C RACTOR or RVEYOR or AGENT n <br /> �� a <br /> d <br /> ADDRESS ADDRESS � <br /> ......................... C�✓ u!.,.... t1/....... Y1.. 3.................... <br /> ADDRESS ADDRESS \� <br /> ........................................................................................... <br /> PHONE .....D..N...E.................................................................................. <br /> .. . ...... ............................................................................... WPH � <br /> PLUMBER .ELL. . ..IL...... ..................................................................... <br /> ...D..RLER.. <br /> ........................................................................................... <br /> ADD <br /> ADDRESS . ............S.............................................................................. p <br /> RESm <br /> n 0 o <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms ........ . <br /> o <br /> New Building ... ...... Type of Construction: No. Bedrooms <br /> Addition .......... .................................................... Septic Tank Size Gals. .......... < <br /> Sanitary .......... Size ft. x ft. <br /> Filling/Grading „ ,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving ... ...... Area Soil Type .................................... r <br /> ........................................... <br /> 0 <br /> Mobile Home .......... Slope .......................................... ,. <br /> Privy .......... 3. Use (describe exactly, i -family Perc. Rate ................................... <br /> Well ,,,,,,,•„ home,garage, motel, etc.) Dry Well ..,,...... <br /> Subdivision ,/.... „. Seepage Trench .......... <br /> Camping Unit .......... .................................................... Privy <br /> .......... <br /> .................................................... <br /> Seepage Bed .......... <br /> -------------------------------------------------- <br /> -------------------- <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 <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> a <br /> STRUCTUR FS AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ---------------------------------------------------------------------- <br /> 5. <br /> ------ ---__-----__-----__-------_—_-- —_----_—_--5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> A, <br /> 0 <br /> cg <br /> o �J <br /> o <br /> OC1 <br /> � � a <br /> r <br /> S N r y m Z <br /> s <br /> N. M � m ` m <br /> z o . a <br /> n ' 37 <br /> o <br /> N� m <br /> o <br /> ........................................................................... (/ .J..�............ o C_ <br /> Signature of Owner or Agent Date <br /> X J] <br /> Remarks ......................................................................................................................................................................... TI m <br /> ........................................................................................................................................................................................ <br /> ...................................................................................................... ... ..,/...”.:....... ... .... . ... .. .............. i:1\o <br /> •W`” <br /> mInspection Date ....................................... o.rZoninAms2 . <br /> J 8 0 0 8 0 0 Vf <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 />