Laserfiche WebLink
Burnt*.t County Office of Zoning Administrator Co <br /> APPLICATION FOR SANITARY — LAND USE — WILDING PERMIT 3 <br /> 0 <br /> TO THE 70NING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and looted as '� 7 �= <br /> shown r :ir.�. The undersigned agrees that all work shall be done in accordance with the requirements of the County <br /> Burnett La d Use <br /> Ordinance, Sanitation Code, and with all other applicable Couun�tty_Ordinances/and the laws and regulations of the State of <br /> is$onsin. <br /> EIC/1.... . ....! E...... <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT o. <br /> Ir S Ta <br /> • 9 <br /> t' .....I....................................................................... .................... <br /> r�.�... ............................................................. <br /> ^ <br /> ADDRESS ADDRESS n <br /> .W.�.B.S�.� <br /> .......................................................... ..............S.Opp.!!{�/!-...-..Sdc%.<................................... <br /> . - <br /> ADDRESS ADDRESS <br /> I i <br /> PHONE PHONE <br /> STS ,R .........PSG................. . . y <br /> PLUMBER WELL DRILLER <br /> ....................................... ............................................................................................ o <br /> ADDRESS ADDRESS i` m 6) ' <br /> n o <br /> a <br /> ........................................................................................... ................................................................................. .......... t Q <br /> PHONE PHONE Z ;i4; <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° ' <br /> is <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details •��•�•��•� <br /> No. Bedrooms ..........O i <br /> New Building X Type4 Constpction: <br /> Y <br /> Addition (L-A-Mt — Septic Tank Size Gals. .......... <br /> SanitarySize .............. ft. x .............. ft. .......... <br /> �••. 4a. Absorption Field Site: <br /> Filling)Grading ,,.,,,.,,, Height............. Stories ............... <br /> Moving .......... Area ........................................... Soil Type ......................... ..........Mobile HomeSlope ............................... .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ........................ .......... i <br /> weu ......I... home,garage, motel, etc.) Dry Well <br /> Subdivision .......... Seepage Trench .......... f <br /> .......................... ......................... <br /> Camping Unit Privy . ....... <br /> .................................................... Seepage Bed .. ....... <br /> ------------------------------------------------------------------ --- �a ad <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched In Fig. A. Include e road <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water- If property is located at a hlghw y Inter- � o; <br /> section, show the intersecting highways and the setbacks required along them and at the intersection- CLEAHLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. p <br /> ------------------------------------------------------------------ --__ J <br /> 5. Lot Size: Fig. A. 6. L cation: <br /> .....y. (/. ft. x ..ZGS ft. — ............................... sq.ft. a.u.K7.y..... .......�Z: t✓// No fy F LroyntT ; 1,,. 4, <br /> �e <br /> �N <br /> nN <br /> 0 <br /> 0 <br /> �n <br /> e <br /> ala r��/�ti <br /> Seerjl - <br /> Iq Ll <br /> — F. <br /> T ' <br /> r <br /> Z <br /> v <br /> 9 tnr v rr+ m Z <br /> Z o o' n a <br /> 0 0 n <br /> fA <br /> m o <br /> o <br /> rr <br /> .. Com,-..�.:C� . ...�v�31.�8� = 4 <br /> Signature of Owner or Agent Date o 1i --:i'— <br /> L <br /> Remarks ......................................................................................................................................................................... � :C'; rr <br /> --IG <br /> : <br /> v <br /> .......................................................................................................... ..... ................. ....... P <br /> ` ? <br /> Nrr <br /> rr <br /> Inspection Date ............................. ......... . ./...�..... . ...mi 'r U fru, o ra <br /> ...........................—. ....... <br /> Zonin dministrator <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary hits <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolatioi test must be attached tt <br /> this application before a permit will be issued. Do not purchase or Install a septic tank, do any pl lin ing 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 Administrato,. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE(( AND APPROVED. <br />