Laserfiche WebLink
Burnett County Office of Zoning Administrator v 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use c� CD w <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ,4 a O <br /> R(0\air.d. G. Haixt.4 . c c Ha ua Co.r�s+ . y h <br /> OWNER (please print) CONTRACTOR or SURV OR or AGENT m co <br /> 1.5q. ,5th R . . N R+- t Q <br /> '\ADDRESS ADDRESS h <br /> Carn.b.r i dse.,.....M1.n.n..:....,,6-�roo.$ Wer, er W t 54b93 `° <br /> ADDRESS ADDRESS <br /> yQ <br /> £� J . <br /> PHONE PHONE <br /> PLUMBER WELL DRILLER <br /> 0 <br /> ADDRESS ADDRESS � o <br /> o <br /> PHONE PHONE z <br /> DESCRIPTION 4. Sanitary Facilities: . o o <br /> 1. Work: 2. New Building Details No. Bathrooms v '4 <br /> New Building x Type of Construction: No. Bedrooms CD <br /> Addition .,F-eAme, Septic Tank Size Gals. <br /> Sanitary Size ....A.4.... ft. x ....ca4.... ft v <br /> Filling Height Stories ... 4a. Absorption Field Site: <br /> Moving Area Soil Type ,J <br /> Grading Slope tr o <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate r . (()4 <br /> Privy home,garage motel, etc.) Dry Well C' <br /> Well Seepage Trench n� <br /> Subdivision Privy <br /> Seepage Bed <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig, A. Include road o <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- " Q.• <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING `N <br /> f N <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o' <br /> ' C z <br /> 5. Lot Size: Fig. A. 6. Location: 1` .. a'.) <br /> ft. x ft. — sq.ft. (� v o <br /> c,t w I <br /> 4 .1' 9,) 2 <br /> Gee aMae_hed <br /> o w <br /> m ' en . <br /> 2. 5 <br /> o tJ V <br /> 7' <br /> o <br /> J <br /> 3 <br /> 1v 1-0- <br /> ` X,S m <br /> CD <br /> 0 <br /> DO <br /> 5) <br /> cn <br /> CD <br /> m cm— 7 * cn co <br /> co CCD _. a, CDC • <br /> co. NJ9 - < — A• 0 <br /> z ooCD CD ,3 <br /> •0 --0;3 5. g <br /> o —1 <br /> M o DJ <br /> JA --Op m <br /> Signature of Owner or Agent Date o • <br /> �' C <br /> >.1.1i 7 t ` 6231 x m Remarks. <br /> �° m <br /> CD CD <br /> v <br /> VI <br /> II <br /> p9¢-7nA, � , � m <br /> Inspection Date tx3 o 0 0 0 o (rim <br /> Zoning Admini rator X -J \\ o c o o o c/) <br /> VOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> 3efore 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 /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> Nith 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 />