Laserfiche WebLink
Burnett County Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITd 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describedland u <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements ofl the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the lawsland 3 CJ <br /> regulations of the State of Wisconsin. » i ' <br /> 41,0(1 ?..<...X1 /!^.!9. ......................... .........../-.,.a!. .O c!.v. ........ L..... q \p <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT <br /> 536I�rA <br /> S .....` �. /.:.................... . ....ADDRESS rST.d.......6 <br /> ....................... ........................................ d n <br /> ADDRESS. . m iiJ7 i <br /> NuGo........�..ti..........:e' o .......... Eis7 sy��.3.......... ....... <br /> ..... ................................................ <br /> ADDRESS ADDRESS <br /> .............................................. ....... <br /> PHONE <br /> .. . ...... ............................................................................... .W..EL.....L. . <br /> I <br /> DR . .LLER........ ......................................................I....... <br /> PLUMBER bo <br /> ..... . . . ............................................................................... . ....R...ES..S...................................................................... ....... <br /> 0 o n� <br /> w <br /> ADDRESS ADD.... ° <br /> M ' <br /> ............... .............. <br /> . . .................................................................... . ..........................................................................i....... J <br /> PHONE PHONE......... I Z r- <br /> DESCRIPTION 4. Sanitary Facilities: 1 ° o o <br /> 1. Work: 2. New Building Details No. Bathrooms .. ....... <br /> New Building No. Bedrooms <br /> 0 <br /> /� Type of Construction: ...."' i <br /> Additionw aoa �rWMf Septic Tank Size Gals. ... ... E <br /> Sanitary Size ...R?... ... ft. x /( ft. <br /> ....... <br /> Filling/Grading 4a. Absorption enFieldSite:......... . <br /> Moving .......... Area il yi <br /> o <br /> Mobile Home Slope • • • . C <br /> ........ <br /> Privy .......... 3. Use (describe exactly,'1 -family Perc. Rate ..........................1........ <br /> Well .......... home,garage,motel, etc.) Dry Well 1 ..... S <br /> Subdivision .......... JC'! / 6 Seepage Trench . ........ o QQ.. <br /> ......... ........................................ _ <br /> --Camping unitPrivy <br /> — .......... .................................................... Seepage Bed . ........ :.a✓ . <br /> N <br /> Location of proposed structures and existing structures well sewage systems, roads, etc. should be sketched in Fig. A. c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loca ed at Q) <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. o <br /> ___________________________________________________________________�.__ : 1 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ........... sq. ft. ............................................... ............ . L........ <br /> . <br /> �o�� TK a <br /> -7 <br /> � g Z <br /> 0 <br /> d <br /> to t <br /> o a < O O 5. _. m <br /> T. "a, a m a a <br /> a < <br /> •G< C y > > <br /> O N : w <br /> � D <br /> m (- <br /> � � 1 <br /> row <br /> o - a : <br /> o c In <br /> 0 <br /> DD <br /> �� f... .<.'.tl C <br /> Signature of Owner or Agent Date <br /> Remarks <br /> ................................................................................................................................................................................. <br /> ID <br /> ......................................................................................................... ... ..................... ... ....... (J...........................J.. ... rV,iCJ <br /> Inspection Date ....................................... �� ...... C.tTC(. ` l SSSS 8 S <br /> Zoning Adm st <br /> NOTE: A preliminary site inspection must be made and site app al granted on all structures involving sanitary f cilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank, do any plumbing or start any building until a permit has ben issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> I <br />