Laserfiche WebLink
et- ' e - . <br /> Burnett County Office of Zoning Administrator �' c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '� 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State o Wisco <br /> NO <br /> L.. ..rr.r:. . .. ... ...... .I^.t?.S:?.Q .� ......... ............................................................................................ <br /> OWNER 1pleaaelin. t.l. CONTRACTOR or SURVEYOR or AGENT , it <br /> .: 1.1.......... .1:..ma.rr..Q.h.................................. ............................................................................................ a <br /> A•'DORE S ADDRESS <br /> ADORE .L........ .L.[.!.1.U........ .LL.c... �,.?..Q.S.o�... .ADORESS........................................... <br /> ................................. ............................................................................................ L <br /> xty s <br /> PHONE PHONE <br /> � <br /> ........................................................................................... . ...... . .. . ....................................................................... : <br /> PLUMBER WELL DRILLER <br /> ........................................................................................... . ..... .. ...............'---...........-........-'---.........-........................ <br /> ADDRESS A..DDR..ES..S m' 0 <br /> o <br /> c <br /> ........................................................................................... . . .PHONE. ............................... .: <br /> PHONE <br /> DESCRIPTION 4. Sanitary o' <br /> Facilities: ° orT <br /> `S <br /> 1. Work: No. Bathrooms .......... 'p <br /> 2. New Building Details o <br /> New euildlea .... ,. Type of Construction: No. Bedrooms .......... 11� <br /> Addition .................................................... Septic Tank Size Gals. .......... <br /> .......... <br /> Sanitary .......... Size ...1 ft. .......... ,e4 <br /> Filling/GradingHei ght I.Q.I...... Stories ,,,,,,. 4a. Absorption Field Site: i <br /> ,,........ ... <br /> Moving .......... Area S.d,.. r, Soil Type ...........................I........ i r <br /> Mobile Home . . . .. ......... Slope .......................................... <br /> .......... v <br /> Perc. Rate ................................... <br /> Privy 3. Use (describe exactly,'1 -family 0 <br /> Wi1R ... ho e,garage, motel,a c,) Dry Well .......... <br /> Seepage Trench zSubdiv 'x-��. <br /> Camping <br /> Y`4 ......•... o i <br /> Campinp Unit .......... Privy .......... C S�-J <br /> �Ll 1 Seepage Bed • <br /> ------------------------- r ----- t 'i <br /> Location of proposed structures and existing structures, well, sewage s tems, roads, etc., should be sketched in Fig. A. ^ <br /> -------------------------.... <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is located at of FL <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. )Jw }� = <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ----------- - --- -------- ------- <br /> ------------------------------- J <br /> �l <br /> 5. Lot Size: � 'n Fig. A. 6. Location: ;s <br /> ................ ft. x .............. ft. — ............................... sq.ft. .................... I <br /> imp........... 'Ji. V <br /> Y' t a°° IN <br /> r� N <br /> _> so` ° <br /> ( f € <br /> Z <br /> lid n <br /> .E <br /> N <br /> bo <br /> � d d 0 m <br /> nwp < > > o m <br /> m �n < <br /> o' c: asy <br /> ao< : cy > > 3 <br /> Z Cly •G p tp ,O <br /> O HO D � <br /> o Nn ' <br /> p n o p <br /> Signature of Own 0 Ag t Date <br /> Remarks ............G.!. ° .!....?.!...........:N:.t......v.u.... ...................�UU //VSCc-!� G✓�l'� T `: S : <br /> o : $ <br /> ..............................................................................................v...... . ..... . . . . ..... .. .............. <br /> d tInspection Date ....................................... . ......ntoQ: oo' . <br /> MM <br /> Z.oni.n98. <br /> $ $ Yn <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 or specifications 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 />