Laserfiche WebLink
B77 L.cQ�. <br /> Burnett County Office of Zoning Administrator o 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 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. o. .k� <br /> f's <br /> D. .. ........... � ............ O�T't� .......... .... � <br /> ..... ............. ... ...................... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT V :� <br /> 1..C2.S.yj..... <br /> /st .:...L..4 ... � .......... T. t� a <br /> ................................................. ......................... <br /> ADDRESS ADD <br /> :13.tc »rig.G. .z+!..�...✓✓I,)......S5.�3�. Lj. ?.G✓5'F ��-...........�. .'_`..5........................... � � � <br /> ADDRESS ADDRESS <br /> ............................................................................I.............. <br /> ............................................................................................ <br /> PHONE PHONE <br /> l� (S �t LGr <br /> / ... .....................................F......................................... .......... .. .. . ......................................................................... €w <br /> PLUMBER , <br /> WELL DRILLER � <br /> ...... /f. .'Q..W .i.......vv...................................... <br /> o. .. ..... . . .................... <br /> . .......................................................................................... <br /> ADDRES ADDRESS <br /> o <br /> PU <br /> HONE .. ?..:-....g� ...... . ....... ....................................... <br /> PHONE Z <br /> DESCRIPTION 4. Sanitary ° ooH <br /> 0 <br /> � <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> New Building Type of Construction: No. Bedrooms ... .. �j ' <br /> Addition ,,,,,,,,,,,,,,,,_,,., _ Septic Tank Size Gals. <br /> Sanitary .......... � i <br /> ..�(.... Size .............. ft. x .............. ft.... 4a. Absorption Field Site: N ' <br /> Filling ,..,,..... Height............. Stories ........... 1 <br /> Moving .......... Area ........................................... Soil Type ....... .q. ........................ is o <br /> Grading .. ....... Slope ............3/.C�.......... �. <br /> Mobile Home .......... 3. Use (describe exactly, 1 -family Perc. Rate ........3=.3.:'� r^ '• <br /> .... ......... <br /> Priv Dry Well .......... :C/ <br /> Privy .......... home,garage, motel, etc.) <br /> Wellg See a e Trench .........• <br /> P <br /> Subdivision <br /> ............. .................................... Privy ...... y"� <br /> .......... ..........I. t <br /> Seepage Bed .. t,�• <br /> 00 <br /> Location of proposed sur ctures and existing structures, well sewage systems roads, etc-,should be sketched in Fig. A- Include road 9� °� a <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- a <br /> section, show theintersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING t <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> IN 0 <br /> _-- —ize: — ------------------------------ ---_—_--_-- ----- `J <br /> 5. Lot Size: rQ'aPR-a� Fig. A. 6. Location: <br /> �..3..i�....... ft. x V..... ft. . ............................... sq.ft. ............................................................................... 1r,. <br /> N o. <br /> o � <br /> J <br /> 3 ` 1 <br /> �.\ O <br /> t: <br /> T <br /> Z O <br /> 0 <br /> N d O < d <br /> <. CI <br /> vn. < 0 <br /> Z 0 5 <br /> O _ <br /> of <br /> O <br /> O <br /> ........... ....-ne .... ... ............................... .................. .. . <br /> p <br /> Signature of..Ownerr..or Agen... ..t Date � ° C <br /> X S <br /> Remarks .................................................................................................. m....................................................................... m 0 <br /> n <br /> ......................................................................................................... .. ............ ...... .... . ............................................... <br /> ear <br /> i. IE 66666sp of <br /> 6m <br /> Inspection Date ....................................... f...•..... .4;�................ :10: 0 66 O o o m <br /> Zoning Adir Istrator : �c: 0 0 0 0 0 0 In <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 trust be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do airy plumbing or start any build <br /> Ing until a permit has been Issued. A permit may be revoked It misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specif icat Ions shall not be made without approval of the Zoning Arlministratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />