Laserfiche WebLink
Office of Zoning Administrator d -t Z <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT '- ° <br /> THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as < 3 J <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett v o <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the S <br /> tate of Wisconsin a <br /> Cc <br /> nt <br /> OWNER (please print) .................. ..................................• O <br /> ....,. .. L <br /> —> s CONTRACTOR or SURVEYOR or AGENT — \ <br /> a <br /> ADDRESS .... <br /> m <br /> m <br /> ' ADDRESS <br /> .........................a........ <br /> ADDRESS <br /> ADDRESS A <br /> PHONE........E ............................................................................... <br /> /i . .......................................................................................... �G <br /> S 7 �� PHONE <br /> .. .......................... 7 <br /> PLUMBER ...../................ L' i <br /> WELL DRILLER ? i <br /> ADDRE........................................................................................... \ <br /> SS . .......................................................................................... O <br /> ADDRESS <br /> 'm G <br /> PHONE.................................................................................. n p <br /> . ......................................... . .. .. . � � <br /> PHONE . . . ....................................... o 0 <br /> DESCRIPTION ° <br /> z ' ' <br /> i. Work: 4. Sanitary Facilities: o 0 <br /> 2. New Building Details No. Bathrooms 0 <br /> New Building g <br /> Type�f Construction: No. Bedrooms ? <br /> Addition /` <br /> .......... ....... ....r..d.iii!"......................... Septic Tank Size Gals. v <br /> Sanitary <br /> Size ........r�...,Zft. x ... �/... ft. <br /> ..... �! <br /> Filling/Grading Height............. Stories ......�....... 4a. Absorption Field Site: <br /> Moving Area <br /> SoilType .................................... <br /> Mobile Home '^"• ��••�� � � • <br /> .......... Slope .......................................... <br /> Privy 3. Use (describe exactly, i(-;f amily <br /> Perc. Rate ................................... <br /> Well <br /> X.. hem gar ge, motel, etc. y Well <br /> Subdivision � .. <br /> Dr <br /> ,?gar <br /> ..:............................. Seepage Trench <br /> Camping Unit .......... ; <br /> .......... ..................................... Privy p+ <br /> ______________________________________............... Seepage Bed <br /> Location of proposed structures and existing structures, well,sewage systems, roads etc., should he sketched in Fi <br /> setback, side and back - <br /> Yard dimension and location and setback from all bodies of water. If g A. Include road CT <br /> C i <br /> section, show the intersecting highways and the setbacks required along them and at the ntersecti In. CLEARLY LIt a ABEL EXISTING �t <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> —__------------------------------------------- <br /> 0 <br /> 5. Lot$i-;e: ---------------------- <br /> X n <br /> Fig. A. 6. Location: - <br /> ft. x .............. ft. - JCM <br /> — .�sq. ft. ............................................................................... `3 'AZ <br /> /. <br /> Fi <br /> a:� <br /> Z <br /> 0 <br /> / I r <br /> 01 so Z <br /> so <br /> 71` S m c m ry c m <br /> n Q <br /> -. . . <br /> !na m � <br /> Z o ". " Dam <br /> "o : aaM <br /> -4 — <br /> lla J La <br /> 0 <br /> ignature of Owner or Agent li-�Efc.,d.z r a e o <br /> 9 . .,.�.q..t'...... <br /> �l e C <br /> emarks -/.!.ltrw.z� ./,Od'.7.7.......................................... ..... �9 ��S <br /> X <br /> m <br />............................................................................................................ ... Q <br /> ...................................................................... <br /> ............................................................. <br /> p <br /> u <br /> spection Date ............ <br /> .. /'".."""..................... � YI N O U O N m <br /> Zoning Administrator rc i g 8 8 $ c g y <br />)TE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br />'ore construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> s application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> - <br /> until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> h 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 />