Laserfiche WebLink
Irl <br /> Burnett County Office of Zoning Administrator �' e <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3~ = ~ <br /> TO TT)t ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describe J and q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements f the n <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the Is and <br /> regulations of the State of Wisconsin. <br /> ...... .E....A..Y..1........��r..K.�C..9. ..d ...... ............. ............................................ ........ <br /> OWNE (please print) CONTRACTOR or SURV�YOR or AGENT <br /> 9 i <br /> ADDR S ADDRESS <br /> ....... ...... ....................................................... ...................................................................... ........... ......... °� <br /> ADDRESS ADDRESS ZJ.7 ix <br /> PHON/E��7 PHONE <br /> .. .....::..J..... { <br /> .r... .7"r......................................... .................................................................................. ......... <br /> PLUMBER WELL DRILLER yV�\ E <br /> ADDRESSADRESS n o <br /> D .0 <br /> c <br /> ...... ......... O <br /> ........................................................................................... .P.HOH.0. N..E.................................................................. . <br /> PHONE Z „M, r ti <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details """"' E� o E <br /> t� T No. Bedrooms <br /> New Building '�..... <br /> .......... Type of Construction: <br /> Addition J !;`,2 - Septic Tank Size Gals. .......... E1J <br /> .......... ................... <br /> Sanitary L/ Size ...'�..11.. ft. x ...�..�!.... ft. •• <br /> .......... i <br /> Filling)Grading Height....... ..... Stories ............... 4a. Absorption Field Site: '• <br /> Moving .......... Area < < Soil Type ......................... .......... i c i <br /> Mobile Home .......... <br /> Slope ............................... .......... <br /> Privy .......... 3. Use (describe exactly, 1 •family Perc. Rate ........................ .......... <br /> Dry Well m <br /> Well .......... home,garage, motel, etc.) """"" Z o L3 i <br /> Subdivision ....I..... <br /> Seepage Trench .......... of i <br /> .................................................... <br /> Camping Unit Privy <br /> ......... <br /> ............................................... .... <br /> Seepage Bed 13----- <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. C i+l <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loc 3ted at ' g <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the inters tion. - <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 /> :r <br /> N ti O <br /> O <br /> 2. <br /> I J0 aQ} <br /> N (OUY0ee- f <br /> �-- <br /> J) <br /> V y r D lP OJ <br /> 0. <br /> rn <br /> $N K p m m <br /> „ n : y <br /> n 0 : p <br /> 3 - a'fA In <br /> In <br /> Signa±r "n;e�r or Agent Date _p $ <br /> lo,emvkc <br /> , . r. ................. ......... ........... ............. .......... .................... .................................. M <br /> ............................................ <br /> ............................................................................... ... ......... .............v.................. ......... � � " m <br /> 'Z 8 <br /> Inspection Date ..-: 1....a ............ `�/L"r ini . . . A^ $ $ $ N m <br /> Zonin dministrator $2 $ $ N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitar facilities before constriction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this a plication before a permt will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has teen issued. A permit m:v be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall no be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND %PPROVED. <br />