Laserfiche WebLink
pre-fUeY <br /> Burnett Count _ �' ` Office of ZoningAdministrator d CD 0 z <br /> County c o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 7 a G <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H -h . <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD 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 /> C � <br /> OWNER (please print) �/ / �/ CONTRACTOR or SURVEYOR or AGENT C m <br /> d r t ,9, 2 L lam A-Al:_ a <br /> ADDRESS ADDRESS <br /> iti/ <br /> ADDRESS ADDRESS <br /> N <br /> PHONEA/4 A/ 54,-.1.1-, <br /> ) 1 t z PHONE P-,le m <br /> PLUMBER WELL DRILLER <br /> t i -row A— .°" 0 <br /> ADDRESS ADDRESS 5.j m G� <br /> 174 G9 3‘ ° „,---.4 <br /> PHONE PHONE • <br /> z y r <br /> DESCRIPTION 4. Sanitary Facilities: 9 o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building Type of Co $tr ction: No. Bedrooms .3QCD W <br /> Addition Septic Tank Size Gals. /.110P N. , <br /> Sanitary X Size /147 ft. x 70 ft. NI <br /> Filling Height '1 Stories 4a. Absorption Fie;d Site: n 'NI \ <br /> Moving Area Soil Type 7.fr/Ver o <br /> Grading Slope ai. . Q.. rf <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate , �°'ri <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well „xSeepage Trench ,X <br /> Subdivision Privy <br /> Seepage Bed <br /> ‘1:\ ci") <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road <br /> setback, side and back 6 <br /> yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q- I <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> • <br /> \p <br /> 5. Lot Size: j u Fig. A. •• <br /> i.3.AP ft. x !7v�Q. . ft. — .:L'P...O.SG .... sq.ft. <br /> ..-4V-.' 4:' <br /> CD <br /> IC ' o p. <br /> . cli - <br /> 442- ./z ...- <br /> i ' /". " eAtel <br /> `)-7 —� <br /> 0 <br /> o� �a � / � o <br /> •I's 1$ .-61r 0) <br /> 0 <br /> *Z.-7/049 W )4, <br /> t:,... CD <br /> k., Nt. <br /> DO C v v'W <br /> n cr m <' cc D C• Z <br /> -o N a a� - R <br /> -o cn .0 <br /> Z Oo CO --, 7e <br /> o = <br /> o 7 <br /> O <br /> /X.I.,7‘...4...:. zi,....47 "( -0 rr <br /> teze:-/ -7 0) <br /> // C <br /> Signature off?Owner or Agent / D e ° 7C <br /> rr <br /> Remarks 6rK'J Ar a tP CDD x C <br /> g\. _ po <br /> Il .6 w� <br /> - 1 U V rr <br /> Inspection Date r;7.1' - �%� y O u, o , Orr <br /> Zoning Administrator h1 o o b o v <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 />