Laserfiche WebLink
jounty Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> THF-ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as — <br /> cwn herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use e}� <br /> irdinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> :. .9.. .e..! ................ ....I..r..D...e.r.................... ............................................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> sTill.............................................�V a � <br /> ADDRESS ADDRESS '+ <br /> .........w.0 ........................................................................................... _ p� <br /> ADDRESS ADDRESS <br /> .................................................................. <br /> PHRE , PHONE - � <br /> . . . hl01rl.. o <br /> nl5.......................................... ...... . .. . ........................I..bv .................................... s <br /> p..... <br /> PLUMBER WELL DRILLER <br /> .......... <br /> ........................................................................................... .................................................................................. o <br /> ADDRESS ADDRESS 'l m M <br /> ........................................................................................... ............................................................................................ Z o <br /> PHONE PHONE <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° iT <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details """"" <br /> New Building .......... Type of Construption: No. Bedrooms .c . <br /> �" Septic Tank Size Gals. .... <br /> Addition .... .�.. [.e). . ............... <br /> Sanitary Size .............. ft. x�............ ft. 'Q � ' <br /> Filling/Grading .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving ......... Area ................................. .... Soil Type .................................... r <br /> o . <br /> Mobile HomeSlope .............................. <br /> .. ............ •+ <br /> ........ :G <br /> Privy 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... L <br /> Subdivision .....-... Seepage Trench .......... ;%t7 <br /> Camping Unit .......... ................................................. Privy. <br /> Seepage Bed `L{./ 7T <br /> ___________________________________________________ __________________ w— <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 <br /> yard dimension and location and setback from all bodies of water_ If property is located at a highway Inter- i� EEC- :Z <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING < -a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o � <br /> 5. Lot Size: Fig. A. 6. Location: i i <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... _ <br /> N <br /> .AS `(LQJ N '� O <br /> o 1 J <br /> 3 �} <br /> U a <br /> � r <br /> �G Q � o�Z <br /> CJ <br /> G <br /> 31Nr9 < .ym $ <br /> C d < < d o m <br /> a < m 2 F <br /> c — n <br /> ZZ o < � � am <br /> oo' n g77 <br /> 0 0 nm 3 <br /> fA <br /> ' .0 <br /> � m <br /> � <br /> p• �• � <br /> rn. . .................................... �5.......... <br /> ........... o C <br /> Signature,o/f�Own✓er or ent Date <br /> C/ ll.. d .L—. . w X z <br /> Remarks .... . ................................................................... ................................................................................. 0 <br /> w ' <br /> ... ..................................................... . . ... .... ... . ...: ................. ............. <br /> Zoninging Atord.................... 8 8 S g T <br /> Inspection Date ..:..`.l 'y S a?f2� N m <br /> .. . ....... 1 (�ga �, <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 loe made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS .OFFICE AND APPROVED. <br /> J <br />