Laserfiche WebLink
e)-gr-z C'� - ,"I <br /> 'J <br /> Burnett County Office of Zoning Administrator 0 0 <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 < 7 YQ <br /> y N W <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the regwrements of the Burnett County Land Use m e <br /> 9 9 <br /> Ordinance,��Iea Sanitation <br /> Cade, and with all other applicable Count Ordinances and the laws and regulations of the State of Wisconsin. � ma <br /> RG .. PNP <br /> r1�L W <br /> .................... ................................... ........... <br /> OWNER se print) CONTRACTOR or SURVEYOR or AGENT aC <br /> a <br /> d � O <br /> ?r <br /> Ew <br /> ADDRESS } ADDRESS V <br /> 5 ....0.�. ...e.t.,...... i r........ . . <br /> ADDVi ESS ADDRESS <br /> Z./..5..... �. <br /> .....7 7.2 3........................... ............................................................................................ v, <br /> PHONE PHONE p , <br /> ........................................................................................... .. ......... .......................................................................... V <br /> PLUMBER W..EL.. L DRI..LLER SCI! N <br /> ........................................................................................... 'A'Di...................................................................................... <br /> O_ <br /> ADDRESS ADDRESS m o <br /> 0 <br /> ........................................................................................... ............................................................................................ o • :1 <br /> PHONE PHONE Z y r s <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° ' <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details "' o <br /> New Building ...✓ TYP�q of Construction: No. Bedrooms .......... a i <br /> Addition .......... .....Cr r.d �'........................ Septic Tank Size Gals. .......... <br /> y... <br /> Sanitary .� y' ... <br /> .......... Size ...�. ..... ft. x .... ... .. ft. <br /> Fillingl Grading „ ,,,,,,,, Height............. Stories ....�......... 4a. Absorption Field Site: <br /> Moving .......... Area .� Soil Type .................................... o <br /> �S.a..r ..,... �l........ n. <br /> Mobile Home .......... - !.. .. Slope .......................................... r. <br /> Priv / Perc. Rate ................................... <br /> Privy 3. Use (describe exactly, 1 -familyft <br /> Well .......... Dry Well ”""""home,garage, motel, etc.) t <br /> Subdivision .....,,... , ,�.- Seepage Trench .......... <br /> .... N ..... ...�........................... .......... f <br /> .' Priv <br /> Camping Unit ,,,,...... y <br /> Seepage Bed ......... .N <br /> � 1 <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc-,should be sketched in Fig. A. Inc ude roadC • ; <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- -2 >y'� o-J <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING <br /> --SrHUCTURES <br /> ---AND PROPOSED STRUCTURES AND ADDITIONS. p' <br /> 5. Loj Sys"" /, /S Fig. A. 6. Location:'7`� <br /> ../........... ft. x .............. ft. — 4' .. . .... .� e'ya <br /> 1 � P <br /> 0 . o <br /> c <br /> w. t <br /> i S <br /> Z <br /> 7i�� <br /> 2es <br /> 4- <br /> N <br /> M (n r T m m Z <br /> m Nd r1 � d ¢ CO <br /> Z 01T1 <br /> 0 � D n <br /> v - <br /> / / i, <br /> ...... t e, of 'w' ne. .....ge .......... ......... ...... . ......... o � � � C <br /> Sig at re, of Owne or Agent /Dat — <br /> X 37 <br /> T m <br /> Remarks .......................................................................................................................... 0 <br /> ee ' <br /> ........................................................................................................................................................................................ — <br /> � n <br /> .......................................................................................................... ...... ................................................................... <br /> is H <br /> 1 N N + W NVn <br /> Inspection Date ....................................... LIlI�................ .�..... ..... ... ...................... N <br /> T <br /> Zoning Ar '�' 8 0 0 0 Sn <br /> NOTE. A preliminary site inspection must be made and site approval granted on all structures Involving Sanitary facilities <br /> hefore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached ft) <br /> this application before a permit will be issued. Do not purchase or install a septic tank, rlo any plumbinq 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 />