Laserfiche WebLink
3urnett County Office of Zoning Administrator cip- 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> o; rr O \. <br /> FO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as -` y '" C <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use co; <br /> Drdinance, Sanitation Code, and with all other applicable County Ordinances n t laws and regulations of the State of Wisconsin. -' o- <br /> o- O <br /> 9'0114,ncd.V...... .. : <br /> DWNER (please print) CONTR TO SURVEYOR or AGENT co gi <br /> 0 <br /> a 11 <br /> ADDRES , "--z/g`7J ADDRESS ,eicc <br /> J ��'� <br /> ADDRES i (ezi& ) i i ADDRESS .0 <br /> PHONE r' PHONE ..„ k <br /> PLUMBERd — ��4 WELL DRILLER ! <br /> 0 <br /> ADDRESS ADDRESS h o <br /> PHONE PHONEZ z • <br /> DESCRIPTION 4. Sanitary Facilities: •0 o ° <br /> Bathrooms Iv <br /> 1. Work: 2. New Building Details No. ""' "" 8 <br /> New Building Type of Construction: No. Bedrooms co <br /> c <br /> Cld; �� Septic Tank Size Gals. <br /> Sanitary Size ....i.6.. ft. x ...A...Z. ft. <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type o <br /> Grading Slope 4 N h <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate <br /> Privy home,garage, motel, etc.) Dry Well <br /> Well ./ SPrivy Trench <br /> Subdivision <br /> Seepage Bed I <br /> H <br /> c <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road 6 <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 the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. I o • <br /> VJ <br /> f <br /> 5. Lot Size: Fig. A. 6. Location: y-,l <br /> ft. x ft. — sq.ft. <br /> hi coo <br /> N O' <br /> o 7 <br /> m <br /> O \. <br /> 0 <br /> rr <br /> —I <br /> o <br /> O <br /> Q o <br /> / 3 <br /> > J4Dt 1 A z , <br /> 0 <br /> DJ <br /> m <br /> //1/6'AAAC— <br /> 7 <br /> CS <br /> co <br /> \ <br /> jaz,,erueril m cnr7, cnocco <br /> c m c c co <br /> m. N Q a< - '-r a - <br /> / -0 cn < c °' 0' 0 -0 <br /> Zoo `D co <br /> o• m • • xi <br /> :_ � <br /> 01 . • 4' --I <br /> UA o <br /> Veriva 19,../9,-2.2.1-7,....- i e;v_ ) ret Ts , <br /> ).(Ari <br /> Signature of Owner or Agent Date <br /> X 73 <br /> Remarks 1-i <br /> m <br /> 0 <br /> Q it <br /> �/ <br /> Inspection Date ,/ f . tr '" -.1 <br /> 0 0 0 0 r,,) m <br /> Zoning Admirt'fstrator ,t ,) 0 0 0 c 0 o cm/s <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 he 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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />