Laserfiche WebLink
�S–j7 ✓L7J � �- <br /> 3urnett County Office of Zoning Administrator ) o <br /> APPLICATION FOR SANITARY — LAND USE -- BUILDING PERMIT3 = <br /> m r o <br /> -O TN.E ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < N ;p <br /> hown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m e <br /> )rdinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> I Q _ C ?� 0 <br /> 0 Rh N Q C � �MR�. ^ m £ <br /> .. ........ ..... ............... ............................................................................................ <br /> )WN ER (pl ase pr' t CONTRACTOR or SURVEYOR or AGENT a <br /> '4. .s.. .`C.r'..........W�'.S..G <br /> >DDRESS ADDRESS .3 .� <br /> .................. ( ^+\ <br /> .......................................................................................... <br /> 4DDRESS ADDRESS <br /> SHONE PHONE : .p <br /> .......... '_� i <br /> ........................................................................................ WELL DRILLER <br /> LUMBER !"a . <br /> ( iQ <br /> 4DDRESS ADDRESS '`V M c <br /> c <br /> ........................................................................................ .PHONE....................................... ...,................................... =1 .+ <br /> HONE Z r <br /> DESCRIPTION 4. Sanitary <br /> Facilities: ° o <br /> 1. Work: No. Bathrooms ......... 3 <br /> 2. New Building Details �o <br /> New Building Type of Construct' <br /> No. Bedrooms ;(h m <br /> Addition 1.. .... .. ........ . p S� <br /> ' 4a. Ab>Rrption Field Site. <br /> g Sanitary / f c Se tic Tank Size Gals. . <br /> Flling .......... Height............fStories <br /> ..�........... Soil Type'....................................t� <br /> g i <br /> r <br /> Slope .......................................... <br /> Gredng —o <br /> Perc. Rate ................................... i <br /> ic <br /> Mobile Home 3. Use (describe exactlyCl -famil F <br /> Privy .......... home,garage, motel,etc.) Dry Well .......... <br /> Well Seepage Trench .......... E <br /> Subdivision Privy <br /> Seepage Bed .......... 0 <br /> ----------- M <br /> Location of proposed structures and existing structures,well,sewage systems,roads,etc.,should be sketched in Fig. A. Include road t,:,,j 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- W is a M <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING p 4 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. ------------------------------ o e 0 <br /> 5. Lot Size: Fig. A. 6. Location: Y <br /> C <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... <br /> ;r' A <br /> (D <br /> 0 <br /> O [G O <br /> :I— <br /> M <br /> i S <br /> Q� <br /> +V <br /> T <br /> W <br /> Z <br /> O _ <br /> -m <br /> _ <br /> in <br /> m <br /> :4N <br /> � r/fryco Z <br /> <'N c N <br /> ' O -V <br /> ZM <br /> oom `D <br /> 0 <br /> Ul : <br /> 0 <br /> �" .- .�..�..4 ......... p <br /> ........... ...... . ...... y.. ...................................... : p <br /> Signature of Owne r Agent - Date '* <br /> / X <br /> Remarks .. ,1... ...4 -u-�-.... _ - ` ' p <br /> .........................../..6:z#/ ..1.! .. t c'G'..Gfi�1.Q GK..' all..................................... <br /> P <br /> Inspection Date ��................................. Q!h (.:. . ............. .... i 0 0 0 0 0 o m <br /> Zoning Ad inistrator�� i o 0 0 0 0 o 0 <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 />