Laserfiche WebLink
Burnett County Office of Zoning Administrator c - 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT . <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 e (A <br /> 4. <br /> _a <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. n <br /> L:47/9 g irs- L 0..Dg k mffie le C 19 Ai<r.)..1 <br /> q v_., 7e. tordliA511/N5 ‘,1 t - * <br /> OWNER (please print) CONTRACTOR o URVEYOR or A,tEENT , <br /> O_CD CD <br /> 1/1/. 4,t?. A.e 19 0 b j- al. ),....a)1 <br /> ADDRESS ADDRESS ro t <br /> ....M..i...0../.1.€.125 n kcc. , l) n ss 3 3 <br /> ADDRESS ADDRESS is <br /> /- 6/c - 9s° .8716 76.6 - T,3 ,2-- <br /> PHONE PHONE '` <br /> iN <br /> PLUMBER WELL DRILLER <br /> 0 <br /> ADDRESS ADDRESS m 0 <br /> o o <br /> r* < <br /> o ,rt <br /> PHONE PHONEz H r <br /> DESCRIPTION 4. Sanitary Facilities: •o o o <br /> 1. Work: 2. New Building Details No. Bathrooms or <br /> New Building Typ of Construction: No. Bedrooms CD <br /> 0 <br /> Addition ['/ 0,17'(,-h,,,-:.,,Q„ , Septic Tank Size Gals. <br /> Sanitary Size ...IA..... ft. x /24-.... ..1. ft. J <br /> Filling/Grading Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type r <br /> o <br /> Mobile Home Slope t` <br /> Privy 3. Use (describe exactly, 1 -family �;. <br /> Perc. Rate <br /> Well home,garage, motel, etc.) Dry Well y <br /> Subdivision Seepage Trench 't <br /> Camping Unit Privy <br /> Seepage Bed s� <br /> c <br /> Location of proposed structures and existing structures,well, sewage systems, roads,etc., should be sketched in Fig. A. Include road (r _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- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING IQ\ <br /> • <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. 7-, <br /> 5' <br /> 5. Lot Size: Zee_ a41 rAc!-I)e Fig. A. 6. Location: <br /> ft. x ft. — sq.ft. Q <br /> o CD <br /> _ n <br /> N O' <br /> O c <br /> c '^ <br /> 7 /lY <br /> um <br /> _0 <br /> N <br /> f-F <br /> H <br /> CO <br /> c <br /> D <br /> S <br /> c <br /> Z ck <br /> O <br /> 33 <br /> 5) <br /> CD <br /> 1 <br /> Pry <br /> F. <br /> 70 Cn r 7 Z <br /> C <br /> a' sa . N w E,ft ' a <br /> O N • • m <br /> Z O O a • 7' <br /> o o a <br /> Cl 0 <br /> 6-15,;, <br /> �D <br /> • _1m <br /> • _ <br /> dmAt:d....a.. .. ... . 2 ........ ..I.. 9..I.8. 0 <br /> Signature of Owner or Agen Date <br /> �,o <br /> X 70 <br /> Remarks -n mm <br /> CD <br /> N.. u <br /> / <br /> � -Ti <br /> Inspection Date � o/” L lc' 0 TT o 0 o 5Nn m <br /> oning Ad inistratorK U o 0 0 0 0 o N <br /> NOTE: A preliminary site inspection must he 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 he made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />