Laserfiche WebLink
CvI e');0 7 <br /> TI <br /> Burnett County Office of Zoning Administrator W 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as V m <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisiconsin. 3 a <br /> a�. ...1 .. L. ��..r....Gi�tt�...C�.t.� s. � ............................................................................I............... <br /> to <br /> OWNER (please prin ) _ CONTRACTOR or SURVEYOR or AGENT a '� <br /> .. . ........................................................... ........................................................................................... a <br /> ADDRESS ADDRESS <br /> W <br /> p m <br /> .G.r.ainly ✓/�.`.� ,(.-i........... ................... ............................................................................................ t. <br /> ADDRESS J ADDRESS � - <br /> ..`......................................................... .................................................................................:.......... s SZ <br /> PHONEPHONE <br /> .......... <br /> ................................................................................ <br /> . . . ... WE"E.LL.....D....RI.......ER........................................................... <br /> PLUMBER LL <br /> O . <br /> ........................................................................................... <br /> ADDRESS ADDRESS...... <br /> ...... <br /> ........ <br /> ...... <br /> .............. <br /> ..... <br /> ......... <br /> ............ <br /> �........... 0. G)�{- ' <br /> O o i <br /> ........................................................................................... ............................................................................................ o ,» <br /> PHONE PHONE Z 0 <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms ...Q... ' o <br /> New Building ......... T e of Cons�[uction: <br /> Addition ..,>C G,, Septic Tank Size Gals. ....— <br /> Sanitary .....I.... Size ..X.kl..... ft. x ... ft. .......... <br /> Fillingr Grading .......... Height............. Stories .... ......... 4a. Absorption Field Site: <br /> Moving .......... Area ........................................... Soil Type ........................ ........... i <br /> Mobile Home Slope .......................................... ('1 :rf <br /> Perc. Rate <br /> Privy ,,........ 3. Use (describe exactly, 1 . family DryWell ......I... <br /> Well .......... home,garage, motel, etc.) <br /> Subdivision CC �... ................ Seepage Trench ................. ......... <br /> Camping Unit .......... Privy .......... �6 <br /> .................................................... <br /> Seepage Bed <br /> -------------------------------------------------_------------- <br /> co <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig- A- Include road e <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- W <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection- CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> (1� <br /> o. <br /> JU... fon: <br /> -----------------_ <br /> 5. Lot Size: Fig. A. 6. c <br /> .....-+T.L'..... ft. x ... ft. — ............................... sq.ft -----------I <br /> � � <br /> g <br /> be <br /> oU <br /> r,101 <br /> s c <br /> fill <br /> �1u0 :50 �o fiS t <br /> o �f <br /> o �+ 'S:— <br /> to ra wz <br /> c m c m <br /> d2� k r� bP � tiaam aF <br /> P U < y <br /> n 7 <br /> O _7 n i <br /> J ' <br /> O _ <br /> O 7 <br /> m <br /> g :.... i�...................... ... 5. .�..�..L�. 6...... o c <br /> Signature of Owner or Agen ate <br /> X 7 <br /> T <br /> Remarks ...............................................................................................................................................................�... ...... n� � <br /> m : <br /> cs <br /> ........................................................................................................................................................................................ — : : : : <br /> u <br /> ........................................................................................................ ...... ................... .. ...... .................................... <br /> Inspection Date ....................................... f/% ...y ..... ........................ u 0 o N o U c, <br /> Zoning Ad Inistrator �� S 0080000c, <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitieS <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing 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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />