Laserfiche WebLink
62 2 <br /> Burnett County Office of Zoning Administi ator <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work describe d and '2 p 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements c f the m r� <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. <br /> AMO4..� k�.r.at&v. .. .... .................. ........................................... ........ n _ <br /> OWNER (please pri.nt) CONTRACTOR or SURVEYOR or AGENT <br /> I. <br /> .... <br /> DO <br /> ADDRESS ADDRESS <br /> { <br /> ................ -. .................... ...... �? r <br /> .......... . . .................................................................... <br /> A�'IDDR�sESS�r �r_ yJ ADDRESS <br /> .. ONE <br /> N�!.......1. M....��kli................................................. .PHONE....................................................................... ........ 1W x:-11 <br /> PLUMBER.................. —...................................................... .WELL DRILLS..R................... <br /> ................. <br /> ............. <br /> ......... ........ <br /> ADDRESS ADDRESS m C) <br /> N_ < (� <br /> ........................................................................................... ..................................................-............................... ........ o .: <br /> PHONE PHONE Z „Z, r <br /> DESCRIPTION 4. Sanitary Facilities: ° o r <br /> 1. Work: 2. New Building Details No. Bathrooms r c iF <br /> New Building Type of Construction: No. Bedrooms <br /> •y.... � <br /> Addition ,,, ,•••,••,,,, �y Septic Tank Size Gals. ...... <br /> Sanitary .......... Size ......D..... ft. x ... .... ft. ........ <br /> 4a. Absorption Field Site: A <br /> Filling/Grading ••„•..... Height............. Stories ............... i <br /> Moving Area Soil Type .......................... ......... i im <br /> r <br /> Mobile Home Slope ................................ ......... <br /> v <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ......................... ......... i <br /> Wall .......... ome,garage, motel,etc.) Dry Well ......... <br /> Subdivision 4= Seepage Trench z <br /> n .. .... <br /> Camping Unit .......... n �M. ....Y.v!...!!rry..xp!!R�.Cr. Privy ......... �, <br /> Seepage Bed •o--------------------------------------- ------------- ---Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in F g. A. :�v :L <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --- -- Ky <br /> 5. Lot Size: .......... sq.fA. 6. ocatigry r. .N1.C9.!'!...�.p...lG la ? k J. . �... <br /> .28 39(0 <br /> ................ ft. x .............. ft. — ......,/............ (R.... ... 1 . <br /> SEP <br /> lit X 140 't !9 I X 303 �o t�oAq ►`l west, Tbw� of Ras <br /> N O <br /> O J <br /> J .0, <br /> o p c o <br /> rt ur •epi° ExtsPHt, €3 <br /> ,� �to ; t P�rkIYr�DiNLe ( �1 M_ z <br /> O I O <br /> �kr nn M <br /> � axcfr.r' a+ayK or �•aK�: � �— <br /> ,�® ' eurrer4 louAl 9Y ' <br /> ,Z4rxR�r 94 a �a M 0 W 0 a C <br /> m, �n < � c C ' n a y <br /> L ooh. on <br /> Z O.l tO tO <br /> rn <br /> n . rnm <br /> Signature of Owner or Agen �-(,� Date <br /> C,,,, `r / <br /> Remarks .....�..3N ..... T -�. .171L .,,,j I„!U Y;.K�'... k?...�.�-..(.�! ........................ ...... m a <br /> �........ ... <br /> N <br /> .......................................................................................................y...... ..................... .. ... . .................... ... : O <br /> .. <br /> Inspection Date ....................................... ..... <br /> N m N m <br /> .... .. ... ...:. ..... ...5:�'..M .. .. . ...... lx (T (n O <br /> Zoning Administr or g g g S y <br /> NOTE: A preliminary site inspection must be made and site a r al granted on all structures involving sanitary f c l ities before construct io <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 been issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans oi 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 PF OVED. <br />