Laserfiche WebLink
BurnettZountj Office of Zoning Administrator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 6 3• 30 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 7 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 C. ;Q <br /> regulations of the State of—W7iisconsin.) <br /> r A <br /> OWNE (plesu print) / CONTRACTOR or SURVEYOR or AGENT <br /> t cn.... .... ... .... ...9.................................... . ...... .......... . <br /> d <br /> A � . I� ........................................... ADDRESS 'L \ <br /> . .. .........f2,1DX.............11. ..................................................................................... ...... <br /> ADDRESS ADDRESS ? C� <br /> PHON ................................................................................ .PHONE...................................................................... ... :Tx <br /> �� � 'PS <br /> ! ............. ....... ........................................................... ..................................................................................... ...... <br /> P UM E WELL DRILLER <br /> `\ r . xrQ <br /> .'1C).... ... ..1... ....IL.V.i'.... ."...I ...................... ................ O it <br /> ................................................................... . .� <br /> ADDRESS ADDRESS 0 o . I <br /> .......................................... ...... O .i <br /> _. < <br /> ........................................................................................... .......................................... . - <br /> PHONE PHONE 0 0 <br /> DESCRIPTION 4. Sanitary Facilities: i °_ 0 » ;�\ <br /> 1. Work: 2. New Building Details No. Bathrooms .. ....... O c io <br /> New BuildingNo. Bedrooms ..... <br /> ,,,�(.... Type of Construction: 9 <br /> f h4 N -� <br /> Septic Tank Size Gals. .. .. ... <br /> Addition .......... ....... .. ........................................ S < <br /> Sanitary ...x.... Size ....:�..Q. ft. x ..........e.. ft. ....... <br /> Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area ........................................... Soil Type ............................ ....... H r <br /> Mobile HomeSlope .................................. ....... •C <br /> .......... <br /> Privy .......... 3. Use (describe exactly(.:,::_:family. � <br /> Dry Well T iE ' <br /> Well .......... home,garage,motel, etc.) " """' Z � <br /> Seepage Trench .. ....... o i <br /> Subdivision .......... . .......... <br /> ........................................ . Privy <br /> Camping Unit ' <br /> Seepage Bed [ .. X>� <br /> Location of proposed structures and existing structures well sewage systems, roads, etc., should be sketched in Fit]. A. :�t .c <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at :� ? im <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersec ion. N <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. _ :� 0 <br /> -------------------------- ---------------------------- — .� <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ...................................................................... ........ <br /> V CL <br /> N <br /> Vv CvvlN :c <br /> r <br /> �jLL Oe- t4or:5-L0 <br /> a3 7 <br /> o z <br /> >o <br /> a <br /> e <br /> m <br /> 1 <br /> t1 � <br /> (�4t m mmrD <br /> mm `2 on mnmogmcm <br /> In <br /> �nc � <br /> na � <br /> ao< wcy > > 3 <br /> Oto •< p •p m <br /> oN� Noa : a <br /> b <br /> 9 0 0 <br /> � c C <br /> .�"i............ ....................................................... .. ................... ............... � � � p <br /> Signature o Owner or Agent Date $ <br /> �; N <br /> Remarks <br /> H � <br /> ................................................................................................................................................................................. ...... c <br /> o . g <br /> ............................................................................................................ .... ............ ..r[ .. <br /> ✓ <br /> Inspection Date ...................................... ...... ��r. .... :2.-..—....................naZoning d.mistrtor ....... ..... <br /> T <br /> g $ <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary fi cilities before construction vvv <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application 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 bee n issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND AF PROVED. <br />