Laserfiche WebLink
e'77C C,..) <br /> C.i <br /> Burnett County Office of Zoning Administrator v o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT v. -. <br /> o g <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < H J <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD CCD j <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 o.. N/Z .C\ <br /> N h C <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m . n� <br /> a <br /> 1.Q .Q.S�7 tR► -m c - (-- Ac 1.)b Q a <br /> b_n <br /> ADDRESS .` ADDRESS F-tr) t <br /> • <br /> ADDRESS �� j PA�K, M sSyyS ADDRESS <br /> 1.3 <br /> L{ aSs-Ssyq b }" <br /> PHONE PHONE 1 <br /> °V ttt• <br /> PLUMBER WELL DRILLER <br /> c <br /> ADDRESS ADDRESS c 0 <br /> r* < <br /> o' .--.:- <br /> PHONE PHONE z u, r <br /> DESCRIPTION 4. Sanitary Facilities: •o o ° <br /> 1. Work: 2. New Building Details No. Bathrooms o <br /> New Building Type of Construction: No. Bedrooms �" <br /> Addition Septic Tank Size Gals. J <br /> Sanitary Size ft. x ft. -, <br /> Filling Height Stories 4a. Absorption Field Site: <br /> Moving Area Soil Type o <br /> Grading Slope ,-» <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate <br /> Ils <br /> Privy ✓ home,garage, motel, etc.) Dry Well <br /> Well Seepage Trench <br /> Privy Subdivision s),.: <br /> Seepage Bed <br /> k (/) <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road -4:._ 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- fl- <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING r N• <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. t o' <br /> c' z <br /> 5. Lot Size: Fig. A. 6. Location: -., <br /> ft. x ft. — sq.ft. <br /> n <br /> �% V) <br /> CD <br /> C) <br /> Li ---------". � k � 5. <br /> o <br /> ra° 0 <br /> co <br /> ` o <br /> ti <br /> 5. <br /> - <br /> N -n �. <br /> -. o <br /> ?L/ z <br /> 0 <br /> 5 <br /> c2 QOCD <br /> w <br /> �D X <br /> -----------> ' cD CD • - �WCD <br /> m. Naa 7. i2 � <br /> -5 of < n' 5. 0C 'O <br /> Q N N G m <br /> z oo' `D m 70 <br /> pri Ut.ie Rd- an .. <br /> to <br /> .. . e.„6,___ y— 2 7 --$V ovc,(00 <br /> Signature of Owner or Agent Date o C <br /> X N <br /> Remarks � Is, m <br /> � 0 <br /> AU 7 Zie �f ✓t9a-,s/ ,_-5- deep, CD _ •l' <br /> SU ii <br /> i t% <br /> e <br /> Inspection Date , Zir171-"'/ -• <br /> o . c -n <br /> m <br /> Zoning Ad istrator o 0 0 0 o V) <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 />