Laserfiche WebLink
pir,L2+y/� <br /> Burnett County Office of Zoning Administr for W "gf <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 3 <br /> d ,; <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '� M <br /> # <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,$ S <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> ........................................................................................... ........................Tja ..�.�........................................... ...... <br /> OWNER (pilase pri pt) /I CONTRACTOR or SURVEYOR or AGENT a <br /> ��.ari s <br /> . . . . . ...............f................. ...... . ......................... � ^ <br /> ADDRESS, ADDRESS � <br /> f ,..��� ....R1.......................................... ............ ........................................................................ ...... <br /> ADDRESS/-� L ADDRESS <br /> .. . .....f/ J1 ../..............................................�� <br /> PHONEy . . . ............................................................................... ...... 'J <br /> ............... ........ <br /> .. . ................................................ <br /> PLUMBER . ................................................................................... ...... <br /> ....... : I . <br /> WELL DRILLER <br /> ADDRESS .A........ S-S...................................................................... ...... :V 1 <br /> DDRESn 0 <br /> ti o <br /> ........................................................................................... T'\ <br /> PHONEPHONE.......................................Y................................ . j <br /> DESCRIPTION Z <br /> 4. Sanitary Facilities: P c o i9• <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> ... ...... <br /> o <br /> New Building ,........, Type of Construction: No. Bedrooms ... ...... <br /> Addition ,�1'„•, , , , ,.. „ Septic Tank ze Gals. ... ...... <br /> Sanitary .......... Size .. ....... ft. x . ...`........ ft. ... ...... i i <br /> Filling/Grading 4a. Absorption Field Site: <br /> ......... Height............/. S1Zor'as ............... i <br /> Moving .......... Area ......�.i....�................... Soil Type ............................. ...... 'r <br /> o <br /> Mobile Home .......... Slope .................. ............... ...... » <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .... ...................... ...... d <br /> Well .. .. .... Dry Well ... ...... <br /> . ho ,garage, motel a .) <br /> Subdivision ,•,,,••.,. Seepa rench Z .�. <br /> ��jj yt�_ ... ...... W <br /> ....4. 111 l7riY�.:.......... ° : C <br /> Camping Unit .......... Priv ... ...... : I' <br /> ............ .................................. .... T <br /> Seepage Bed — <br /> ___ ____________________ _ . :y <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fig. A. : t <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is locati d atF <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. „`-, <br /> CLEARLY LABEL EXISTING_STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. a' <br /> _____________________ _______ __ <br /> 5. Lot Size: Fig. A. 6. Lo ation: / <br /> ..-1.�4'.... ft. x .`"f.. ... ft. — ............................... sq.ft. <br /> t <br /> t�d ��� f o <br /> a <br /> I1 o E EGO <br /> Fls <br /> I � <br /> O <br /> b <br /> m <br /> �--- 33 C) <br /> —. ---- 31 to V N r D Oo W <br /> 0 «�Q < > > � < <, m <br /> � - <br /> 9 6:5. d c y > > ; <br /> 00 <br /> O O m <br /> O HO . D <br /> Nom ' ya ' <br /> _ a : a <br /> g c m <br /> o `= j <br /> . .. '6 .... ............ .......... ........................... m <br /> Signature of Owner or Agen Date 'o <br /> o : <br /> Remarks ...................................................................................................................................... m;. P ' <br /> ' <br /> �. <br /> o : <br /> ..................................... ................................................................ .. . . .. ......... . . <br /> .. ........... .... <br /> 4N g <br /> .. .................. <br /> NN g <br /> mInspection Date ....................................... In inistrator g gg g U) <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 orspecifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />