Laserfiche WebLink
Burnett County Office of Zoning Administrator CIO I 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N :N-A <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.. 3 a tj� <br /> . .... ....1.J........ ....:.................................................. ... /.///.Cx../If.............../n.<(. . L!.............1'.:L..........�....... - rI S <br /> O ER (please print) CONTRACTOR or SURVE VOR or AGENT a <br /> as <br /> . .'.�./...........f:SO.........../ C:(.5.: .K..0............................. <br /> � rj ....... /.......................................... <br /> ADDRESS ADDR.ESIS <br /> J..... .............. . ./%.z....1.................s.��.l. ...(n ........................f...... ............ `/..... ................... :pp <br /> ADDRESS ADDRESS <br /> PHONE PHONE <br /> P . ...1 Pa ror S r�r �e ✓ �LL ✓fit 7 <t�l?y A C E <br /> :............ . ..... ` ..�.. .. .:.... t.:.:. .......... .. ........../�.....:..n.......... . v <br /> PLUM <br /> KrBI R...../✓1J.P...f.......u. <br /> .......k//...>.:..... --t WELL D. RILL R <br /> .k.•••.•...•....•..•••••••...•.••.••.• .. .... .. ... .t.. ...c.1.'/ .........l':...................................... <br /> ADDRESS ADDRESS \i s. <br /> O <br /> C) :A <br /> 0........ .... ........................................................ O <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: P o ° <br /> 1. Work: No. Bathrooms ...�..... :. <br /> 2. New Building Details � o <br /> New Building ,,....,,., Type of Construction: No. Bedrooms ..... ry <br /> Addition , / ..(.}SRL:.(�......r.X.�.w?r.�..kYl... x'^ J�Se tic Tank Size Gals. ..... <br /> ar p <br /> Crn4I( 5"a0e_ UOc <br /> Sanitary ...El..... Size ...3.. .. . ft. x ..:. ��... . ft. 1........ i'.. <br /> �" i <br /> r <br /> Filling/Grading ,......... Height Z6.1._ Stories ..� <br /> 4a. Absorption Field Site: 1✓0...Z...... <br /> Moving .......... Area l d.� .0....[.�.!:✓../�.*jl......... Soil Type .................................... r <br /> Mobile Home ,,,,,,,,,, <br /> 360 U" L dlr�,. Slope .......................................... 1 ^ o <br /> Privyy, y Perc. Rate ................................... <br /> 3. Use (describe exact) 1 -family <br /> Well ... home, arag mot 1, etc.) Dry Well .......... 1 <br /> Subdivision / /lYwtr-�.. Seepage Trench .......... —C <br /> arwc ..............I.......r....... <br /> ! (((/// Privy --C <br /> Camping Unit "" . <br /> "' --- Seepage Bed J. .X36 ' <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter '� n °- G <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING y._� < a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... s9.ft. ............................................................................... _, ift <br /> m <br /> t6 <br /> N i o� <br /> /I\ V o <br /> lsic, <br /> NJ <br /> j Z <br /> o � <br /> a <br /> I��G BL v F <br /> �yso 'y Fa �Kt�e <br /> V <br /> =7 Nr9 wm' <br /> m <br /> m Vian < "D 2. E . <br /> < C ' . -lam . "7 <br /> �^ \J m <br /> Z 0 o' n 70 <br /> o <br /> yr ° <br /> Z o <br /> tq <br /> Agnature <br /> .... .. ......................... ...................................... SC <br /> of O ner o Agent Date <br /> X M <br /> m <br /> Remarks ......................................................................................................................................................................... <br /> m <br /> Cis, — : : . : : : <br /> n <br /> ......................................................................................................... ..... ............. <br /> oBaSo � M <br /> Inspection Date ....................................... .... .. ........ f? <br /> . . .. ...................... <br /> Zoning Admi strator 0 0 8 8 S 60 S ti <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facllitius <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 riot purchase or install a septic tank, do any plumbing or start any build <br /> - <br /> until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here <br /> is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Adm inistrator. <br /> -WER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />