Laserfiche WebLink
Burnett Couhty Office of Zoning Administrator 3 ? Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> o <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 C cam\ <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> a �! <br /> JAMrs V, c u [ <br /> /7....(...✓...t.�.i ............................................................................................ C » f <br /> � <br /> OWNER (please print) CONTRACTOR or SU RVEVOR or AGENT o. 3 <br /> .. . . <br /> ADDRESS ADDRESS :r <br /> ADDRESS r ADDRESS <br /> `3 <br /> 4 n rn <br /> PHONE PHONE <br /> N.E.. ..5.......... 'oGRPER................................ �w <br /> ;C <br /> PLUMBER WELL DRILLER 1 <br /> lQT<...sp...........1✓E 5i1 R. ........................... ............................................................................................ <br /> ADDRESS ADDRESS o <br /> L6 - 6a 00» <br /> PHONE PHONE Z H <br /> DESCRIPTION 4. Sanitary Facilities: P <br /> 1. Work: 2. New Building Details No. Bathrooms ....a'.. }� <br /> No. Bedrooms o <br /> New Building ...X... Type of Construction: •• ••' :4\ .y <br /> Addition ..... ,,fii! ffir Septic Tank Size Gals. lLICY2. <br /> Sanitary ....X... Size ....aif.�.. ft. x ..terra..., ft. "'• ••'•• <br /> Fillingl Grading ,......... Height.l. . 4a. Absorption Field Site: <br /> .... Stories ....l......... SA ;� <br /> SOII Type ......................Moving .......... Area ................................ .......... NP. .f .o <br /> Mobile Home Slope ..............................31 <br /> .......... » <br /> Privy .......... 3. Use (describe exactly, -fami <br /> Perc. Rate ....................... .... Z <br /> Well ...x.... home,garage, motel, etc.) Dry Well .......... y <br /> V <br /> Seepage Trench .......... <br /> Subdivision .......... ,,,,.,,,i/.D/y.E A <br /> --Cam Ping Unit_ .......... .................................................... Privy ..........7'�.. <br /> See a e Bed ... . N <br /> fw <br /> — 9----------- P m iv] <br /> Location of proposed structures and existing structures well,sewage systems, roads,etc., should be sketched in Fig. A. Include road yC <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway Inter- Aik <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING p <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p o — <br /> --------------------------------------------------------- — N .. <br /> 5. Lot Size Fig. A. 6. Location: <br /> p �L�/t i <br /> ...�Q1Q..... ft. x .� ... ft. . .........,','0c-n........ sq.ft. ............................................................................... o ; <br /> A <br /> N —O <br /> o � <br /> O <br /> �y J <br /> � T <br /> ay is s�' o <br /> 30 <br /> Ale,usI- <br /> M N r 9 ur W <br /> C <br /> / n Q < <br /> xa<naw `G 1M' m <br /> 7S Z oo' m D n � <br /> o <br /> �o S 1 <br /> BrGSAGO SAKE / � c <br /> a <br /> 1n+J aC 1�t0[/............................................ .................... �� <br /> Signature of Owner or Agent Date — <br /> X <br /> M <br /> Remark ....................................................................................................................................................... ................. .� ; 0 <br /> o.t,°.......G. S .t.fJlc. �//� 64.....6, . .. B: �rl.A+�e- .�................ `— <br /> SP .................................� u�ntat ... ��jynrte-.^ � . <br /> ...... ..:...... .../'.".G.� p / ....... ...... ..............J..... .........�ngd <br /> ............ ................. ;Q II T <br /> Inspection Date .../...-'.11.'.... i...... ..... .... .... .. .. �m Imn <br /> U tNT O N O <br /> rator I E 8 8ISISJ8 8 CA <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 tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />