Laserfiche WebLink
�r1(- <br /> Burnett County Office of Zoning Administrator o <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 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use v, <br /> Ordinance,ySanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 <br /> eF <br /> / ��' ,//ztZ H SOU <br /> .............. ............. .. . .... ....................... ............................................................................................ m <br /> . ......�.,.........�. a 000 <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m m <br /> 3.�1lo.G?.........76... �!4 ...�........................ ......................................................................................... <br /> ... <br /> ZADDRESS/,, �////� MM ADDRESS <br /> yEeaUr�? ..�..l.k.:...ssV.7. ........... 'J <br /> ADDRESS......... e. ADDRESS [ � <br /> ��. .z ..... ...ys> ...�?9. ................................ wv <br /> PHONE PHONE � <br /> .................................................................... . ..............LT'E'...................................................................... � - <br /> PLUMBER WELL DRILLER i� <br /> ..... . . . ............................................................................... .... <br /> ...... . i �... <br /> . . . . . .. .. .......................................... <br /> A ........................ G1 m <br /> ADDRESS ADDRESS i A� <br /> PHONE PHONE 0 <br /> DESCRIPTION4. Sanitary Facilities: °r .1 <br /> 1. Work: J 2. New Building Details No. Bathrooms ...... ... i o i _ <br /> New Building ,.,,/, Type f Construction: No. Bedrooms .......... r <br /> Addition Rfry .* ..... Se tic Tank Size Gals. .._...... <br /> .... ..... p p <br /> Sanitary Site .. <br /> .......... ..Cl.... ft. x ...Oz.. ft. <br /> Filling/Grading .....,,,,, Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area Soil Type .................................... r <br /> Mobile Home .......... ........................................... Slope <br /> J.) O <br /> Privy3. Use (de exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home garage, otel, etc.) Dry Well \h <br /> Subdivision Seepage Trench <br /> .......... .......... <br /> .................................................... <br /> Camping Unit ,,,,,,,,,, Privy <br /> .................................................... .......... <br /> Seepage Bed .......... ' t� <br /> _____________________ ______________ -�U <br /> Location of proposed structures and existing structures well, sewage systems, roads, etc.,should be, sketched in Fig. A. Include road <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 'J = <br /> ----STHUCTURFS AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --------- ------- --------------8----- <br /> 5. Lot Size: ,f CR s ' <br /> U T Fig. A. 6. Location: 7� <br /> ................ ft. x .............. ft. — ............................... sq. ft. ..................................................... <br /> (e I I rr N o. <br /> o <br /> � o � <br /> q <br /> O � F <br /> t <br /> 3 s <br /> D ;.0 <br /> 711 <br /> / <br /> -7 t ib.�a-w-� ! Z <br /> `�---� rte-- ro o <br /> 7_4 <br /> III" A <br /> d <br /> O IuEw �` U�ft, 30/� <br /> M n r v N m Z <br /> TI\ /tel r. 'tD-o� ( � <br /> �Nna '� d m '10 <br /> n <br /> Z Oo' � Dnm <br /> O <br /> �oer ... .......7 2A /..$ ...... pSignatAgent / pace C <br /> X <br /> Remarks ......................................................................................................................................................................... T m <br /> v <br /> ........................................................................................................................................................................................ <br /> '. <br /> li <br /> Inspection Date ..... Qi N o o m <br /> ................................. <br /> rn <br /> oning Ad istrator 8 8 0 8 0 CCn <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 /> s (^: 4 1711 <br />