Laserfiche WebLink
Burnett County Office of Zoning Administrator �' .7 gg � <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT m <br /> 2 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work descri ° <br /> bed and q 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulations o eState fWisco in. - a <br /> R .�1�. ....��.1� ..... ................... ........../ o.ci..... ... .. �1.. 5...................... ...... <br /> OWNER (place rintl _ CONTRAC OR or RV V(>-or AGENT iO <br /> L / /J � /$t1 yj-c r / <br /> . . . .......... ..1.....I..........�.U. ......... '- .S.). ... ......... ESS...`.....��.4'..�.f..�.�A ......01.5...................... ...... <br /> ADDRESS � ADDRESS <br /> 5!rent....LJis.... `1 '�. '....... ............................................51/..3...93................ ...... <br /> ADDRESS ADDRESS <br /> .......'.LS. 3 y. .."5 .g.................. ....................8... .. ..".....y.l.. .'?................... ...... <br /> PHONE PHONE <br /> 1�a . ......L/k.3..-.0.9..9..0................................. <br /> PLUMBER WELL DRILLER <br /> . . . ................................................................................ . .................................................................................. ...... 0 <br /> ADDRESS A..DDRESS n O <br /> P............... . . .................................................................... ..................................................................................... ...... O .: <br /> PHONE PHONE 2 <br /> DESCRIPTION 4. Sanitary Facilities: <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ••• ••"•' ` c <br /> New Building No. Bedrooms <br /> .......... Type of Construction: ••• •"•" i •/_ <br /> Addition Septic Tank Size Gals. ... ...... <br /> .......... ....... ................... ............ <br /> Sanitary Size ........... . x ... ...... . <br /> Filling/Grading ..X.... Hei ht Stories 4a. Absorption Field Site: <br /> g ........... ............. 1 i <br /> Soil Type ..................Moving .......... .. .................. <br /> Mobile Home Slope .......................................................... <br /> Privy 3. Use (describe exactly,'1 -family Perc. Rate ........................... . <br /> m <br /> i <br /> 0 <br /> Well .......... home, arage,tel, etc.) / Dry Well .... z <br /> Subdivision / / Seepage Trench .......... o i <br /> .......... (�f... ... .. . ..5.. ............ <br /> Camping Unit .......... ..... . .���.Yt.. Privy .. ....... i <br /> .. ••••"' .. Seepage Bed <br /> ---------------------_____________ ---------------------------- -- <br /> Location <br /> __________________________ __ :�— <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc. should be sketched in Fig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local d at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. :F <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. W <br /> ___________________________________________________________________ <br /> 5. Lot Size: r Fig. A. 6. Loc�jion: n I �- (� p <br /> X10.. r.... ft. x �.... ft. - ....9 /..f� .... sq.ft. .....L I C?.�..�� ...�.�....C...4G�' .. .IYI�f// G 'rn V <br /> •175 <br /> Aclw <br /> C <br /> 0 <br /> C W <br /> .moo <br /> Perm. �proQej swb6�ct- '- Star_ c�P�.t� c«rl <br /> �-,ste� below 7j <br /> p a.1 <br /> l) a/•et� �, l(eCk or cor '� L 'ktn Slo e `la d-A-k 7U be- SW Cone d Z DO <br /> L.>tC� `moos-, + See'Aac( pfw/cKzo' S0 QGt 1rhmec�tatel o <br /> 60 { 1 <br /> a� ROW Tie ci�_ oca <br /> S Copt -fb pye_Uv f- RA w�sl�t I .Jo l ok e <br /> TO JC64L' Ao ay'eE1 <br /> nmZA or�<c >� >a no a <br /> mn m <br /> C p6f Un Je5S � Yoi$ .15 m <br /> �a 42 > A; <br /> . px <br /> \/ //� `` oma / �(.. 1 }f. (..t✓�'1' f»1 n ; m <br /> ir. n o <br /> be 1 <br /> ......... Zall.k...0 ........4............... ......... A ....0..J�`� c7....... o v <br /> a <br /> ignaturk of Owner or Agent Date c <br /> o . <br /> Remarks <br /> u <br /> o . 8 <br /> . ............ ........ ...................................... ..... .................... ...g........ <br /> N T <br /> Inspection Date . ..... `� u, m <br /> ,rte ... ............................ .... Q <br /> /. ....� . . ...... ........ Cj <br /> Zonin Ad nistrator 8 8 8 8 Co <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary IS ilities before cons ruction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this appl cation 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 been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or ilpecifications 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 />