Laserfiche WebLink
C 17.. G-79C�/' <br /> Burnett County Office of Zoning Administrator d 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as 7 iv <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use no <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. a i <br /> r,�,Y N <br /> . ......... ......../VIVA,► E............................. ............................................................................................ o , <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT m <br /> (.....�?.0..(ZT+l...54��N....+09Ap....................... ................................ ........................................................... d �IJUy <br /> ADDRESS ADDRESS <br /> fl ..... ..5.'7. . ........... — <br /> ADDRESS ADDRESS <br /> -�. <br /> PHOt , PHONE <br /> 1Sn. 7�..... .... �t0�.7..................... <br /> PLUMBER t WELL DRILLER :n <br /> A. ...: ..�.. .N� -......6:.y...).0........oyo <br /> ADDRESS <br /> ADDRESS <br /> �.� .....vim '(..rf:"........ �..�1`......................... ............................................................................................ '� o <br /> c� <br /> 0 <br /> PHONE PHDNE Z n <br /> DESCRIPTION 4. Sanitary Facilities: P o o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details .... 10 <br /> New Buildingy No. Bedrooms .. .. t(�J, 0 <br /> ...x.. Type of Construction: ^' <br /> Addition Septic Tank Size Gals. "755 <br /> ..X11.`6.. ..7�...rTjfil':�JE....... \ <^ <br /> Sanitary ....„ Size ft. <br /> Fit l i ng f Grading ,,,,,,,,,, Height.... .... Stories .. .......... 4a. Absorption Field Sit : +� i <br /> Moving .......... Area ..........Ne. ........ Soil Type ..............7V7...............Mobile Home Slope ....................Privy ,,........ 3. Use (describe exactly, 1 -family Perc. Rate ............. ^� . <br /> Well ...��. ome garage, motel, etc. Dry Well .......... <br /> Subdivision .......... ( fie Seepage Trench ...,...... r 'V <br /> Camping Unit ......... Privy .......... <br /> ------------------ ---.................................................. Seepage Bed /8J 7---3- �1 i <br /> ------------------------- ------- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road V pp <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 V o fl <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �^ o <br /> 5. Lot Size: / ,r� Fig. A. 6 Location �t� //,,�,/ IN <br /> "h <br /> ..1.QQ.... ft. x .44'. L.:.. ft. ...4.!..�J._,( ... sq.ft. ......... ...Ti2:! ^. .....C.. ......... ?` V E <br /> t � <br /> m fn a n <br /> in < < ' E, <br /> N -. d so <br /> w . ,� c <br /> o m y n <br /> O O o <br /> fA r: <br /> ba'te' rn <br /> ................ <br /> Signature of Owner or Agent ' . . <br /> X <br /> Remarks ............................................................. m............................................................................................................ � � <br /> v ' <br /> ................................................................................I..................... ............................... 0� .' . . . .' . <br /> Fit!Date ....................................... . . . .�:' G .f. ........... ...... M <br /> Zoning Admin rator/�—J0 0 0�0 8 o�W <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary N\Iios \ <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 />