|
Burnett County Office of Zoning Administrator o 0
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 0
<br /> Pj
<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N
<br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m m •A,t
<br /> Ordinance, Sanitation Code,/and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 c-
<br /> rP. ......... ...4./....9...5..................................... ......................................
<br /> ............ ..4... ..F�.+ . A d
<br /> O NER (please print) CONTRAC OR or SURVEYOR or AGENT
<br /> a ^:
<br /> �1.1..k.a.......N...o.r.. .9.... .!!.............................. ............................................................................................ a
<br /> ADDRE S ADDRESS
<br /> A DRESS ADDRESS
<br /> '' ` fi
<br /> PHNE................................................................................ .PHONE................................................................................
<br /> VL .. (.h..l...................................................... . ........... .. . . ....................................................................... 19i
<br /> PLUMBER WELL DRILLER :Al
<br /> 0
<br /> ..........
<br /> ........................................................................................... ......ADD...R..ES....................................................................... 1 O O
<br /> ADDRESS S Ai m 0 YTS
<br /> 0 f
<br /> ........................................................................................... ............................................................................................ O .i
<br /> PHONE PHONE Z
<br /> DESCRIPTION 4. Sanitary Facilities: ° 0 -0 "
<br /> 1. Work: 2. New Building Details No. Bathrooms 13
<br /> ......... ?� o
<br /> .
<br /> New Building ...Y... Type of Construction: No. Bedrooms ....r�-. ;ten M
<br /> Addition h4 h,,, Septic Tank Size Gals. ..........
<br /> ......... ............... ................ .
<br /> .......... n <
<br /> Sanitary ..• ,,, Size ...a..4.... ft. x ft.
<br /> Filling/Grading ,,,,,,,,,, Height............. Stories ............... 4a. Absorption Field Site:
<br /> Moving .......... Area ........................................... Soil Type ....................................
<br /> 0
<br /> Slope ..........................................
<br /> Mobile Home Sl
<br /> ,,,,,,,,•,
<br /> Perc. Rate ................................... 0
<br /> Privy ,,........ 3. Use (describe exactly, -famil f :r
<br /> Dry Well
<br /> Well ,,,X,,,, home,garage,motel, etc.) """"
<br /> Subdivision ......•... ... 4 '. . Seep
<br /> age Trench
<br /> ....................... ^
<br /> Camping Unit .......... ..................................................... Privy ....I.....
<br /> n Seepage Bed /� u
<br /> � -- �v
<br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road b � Q
<br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- i4 4
<br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING cx
<br /> $
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. w,
<br /> 0 y
<br /> _-
<br /> 5. Lot Size: Fig. A. 6. Location: o :�
<br /> ................ ft. x .............. ft. . ............................... sq. ft. ...............................................................................
<br /> N
<br /> N 0
<br /> o 7
<br /> n
<br /> O
<br /> 'V 0
<br /> 0
<br /> I �
<br /> a
<br /> V C Z
<br /> Z
<br /> O
<br /> 7J
<br /> d
<br /> m
<br /> N r m W
<br /> m fAa n < m n E
<br /> 10 onN C m r m
<br /> Z
<br /> D —f
<br /> 4e . .
<br /> C )a O
<br /> ........................................................................... ..... .. ..
<br /> Signature o�flOwner or Agent Date X
<br /> Remarks'5 �0�..3.3aA............................................................................................................. l7
<br /> . .... .. -'7���...........................................................................................................................
<br /> In
<br /> T
<br /> m.......... ... . . . . . .Inspection Date ...l.-J, .G . .. .. . ...... .. ..... .....
<br /> ZoningA�mor
<br /> F J 8 8 8 8 8 8 N
<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 />
|