Laserfiche WebLink
Burnett County Office of Zoning Administrator d -02 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as o <br /> H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land UseCD c <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a y x5 <br /> WNE (P- .... .�.�,�.am.).,s..................... ......�-.�.k�...C�..o! .s�..................................................... � CD 14 <br /> OWNER (plAase print) CONTRACTOR or SURVEYOR or AGENT CD — m <br /> .....WPS....y.tyd.................... ..0..1...... . ?.X.� -..��..!"9..h <br /> ADDRESS AD . .V.^CV..`�.�.5 ° ` b <br /> DRESS <br /> ..... <br /> ADDRESSADDRESS............................................................................ <br /> ........................................................................................... ..... 6�...a.gyp.......................................................... <br /> PHONE PHONE <br /> JJ rr <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS CD o a� <br /> .......N.................................................................................... .....PHONE.. .................................................................................... �z y. <br /> PHOE <br /> DESCRIPTION r <br /> 4. Sanitary Facilities: ° o ° <br /> 1. <br /> 1. Work: 2. New Building Details No. Bathrooms fit... o <br /> New Building .......... Ty of Construction: No. Bedrooms CD <br /> Addition x,•„ Septic Tank Size Gals. 2$f?O <br /> A ra..�................ E1� <br /> No 1 <br /> Sanitary ..•....... Size ...a.[=?.... ft. x ...a.�.... ft. <br /> Filling .....•.••. Height....It...... Stories . .1.... 4a. Absorption Field Site: <br /> Moving .......... Area ........q.Ob ......... Soil Type .................................... r <br /> Grading Slope .......................................... <br /> Mobile Home 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy .......... home,garage, motel, etc.) Dry Well <br /> Well �' 1 Seepage Trench <br /> °l.! . <br /> Subdivision „•,,, Y11 Privy .......... <br /> 4c.r! . .�.�/..../.�.D..t2.1 ......... Seepage Bed <br /> ----------------------- -------------- ------------------------ to <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- i <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o' <br /> ----------------------- — --------- ----------- ---------- 3 <br /> 5. Lot Size: Fig. A. 6. Location: <br /> 4.SN,4—. ft. x .............. ft. — ............................... sq. ft. <br /> rrCD <br /> -- <br /> 1fiQk�iJo pry <br /> N O <br /> o <br /> _) <br /> o a� <br /> d1 T�hQiQ N <br /> 0 <br /> o <br /> NtT t t <br /> CD <br /> "aSe loa► 7SI U <br /> Z <br /> o <br /> "3 <br /> RT R) <br /> a <br /> N <br /> CD = v �. CD _ CD <br /> T. <br /> _0 cn < <br /> ert Q N N •< (n1 m <br /> Z o o' fD <br /> o — <br /> �, Lo <br /> o _ <br /> .�'10 <br /> AIm <br /> a ?.... ................ ..y. ............. :"0 p <br /> Signatur of Owner or Agent Date <br /> X 70 <br /> Remarks CD v <br /> - <br /> to <br /> CD <br /> ........................................................................................................ ........................ I <br /> Q. - N <br /> Inspection Date ....................................... �it7t.G0 / i o 0 0 0 o cn m <br /> Zoning Admini3trator 1 0000000 <br /> TOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> -lis application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> tg until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> fith 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 />