Laserfiche WebLink
Burnett County Office of Zoning Administrator v CD o 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 0 :C <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use CD C <br /> CD <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a \- <br /> f O <br /> ...................................... ...... F............................................................................ <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a CD <br /> 6 G10 f� : . <br /> ��Q ...... l Q <br /> ADDRESS ADDRESS L1 <br /> �?2tu E <br /> DDRES S. ...... ...... <br /> ADDRESS..........�..y............................................................... .A ............. ................... ............................... � lam` ;� <br /> PHONE PHONE <br /> ........................................................................................... ............................................................................................ V <br /> PLUMBE�i [�• /� WELL DRILLER <br /> .... _. <br /> ADDRESS ADDRESS o <br /> 0 < <br /> Q <br /> '...................................................................... J ? <br /> z r+ <br /> PHONE PHONE <br /> DESCRIPTION H r U <br /> 4. Sanitary Facilities: �4�ls�i " ° o ° <br /> 1. Work: 2. New Building Details OW't+Y i"•q No. Bathrooms ")c <br /> New Building Typ o rCo str cti No. Bedrooms .cX... <br /> C <br /> 1-3 CD <br /> Addition �,,,• ,,,,,• •fy,.,.,,. ��a?y!,(xf�o�i►f�tSeptic Tank Size Gals. <br /> Sanitary Size 3..C..... ft. x .L.�....... ft. V <br /> Fillip f1 . #Z,>,A+•a. <br /> 9 .......... Height.�,�...... Stor es 4a Absorption Field Site:.. .�... ..}� � •� .•�'a�', <br /> Moving .......... Area .SIB?�...�!xl.. �!!� ✓Jim , Soil Type ... ....... `.`mail�+I�H•� r <br /> Grading IU-A gy- ,COW Slope ............................ ............. \ ° <br /> I�'tw I,j <br /> Mobile Home .....•.... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Privy home,garag , motel, etc.) Dry Well <br /> ......... <br /> Well ......... .� Seepage Trench y� <br /> Subdivision Privy J ; <br /> .......... p 9 1 <br /> See a e Bed <br /> ---------------------------------------------------------------------- to <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road a- <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- 0- <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. O H' <br /> -------------------------------------------- ---------------------- <br /> O <br /> 5. Lot Size: Fig. A. 6. Loc ' <br /> G (97. >' — () i t �-_/ �J'�fr l L^&. <br /> �... s .. ft. x ......... .. ft. s ft. ...... ./.+K '!... ....................... <br /> ..�.......`"...F.. ........ Cn <br /> ✓ <br /> L/ram Cn <br /> 0 <br /> 14 <br /> eI= H• o <br /> -J M <br /> � sox <br /> -0. <br /> } ` c -n <br /> ji m <br /> LA f e�/, � <br /> U a/`j"�/t�zm <br /> T)hte, `° <br /> f � � � fdW i•�v�� •�,` <br /> CD <br /> C d <br /> �. b N c m <br /> CD o CD fD <br /> OLo <br /> = <br /> b <br /> o � <br /> Signature of Owner or gent Date rt — <br /> Remarks m '• <br /> CD <br /> CD <br /> .............................................................................................................. ............... ............. c <br /> N TI <br /> Inspection Date ....................................... �i/L <br /> ` 00000cs, m <br /> Zoning ministrator 0 0 0 0 0 0 N <br /> 000000 <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 /> his application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ng until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> vith 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 />