|
--& 7, Ooo-7/J 1110-1
<br /> Burnett County Office of Zoning Administrator o o
<br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3
<br /> 0
<br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as <
<br /> shown herein. The undersigned agrees that all work shall be done In accordance with the requirements of the Burnett County Land Use
<br /> m
<br /> Ordinance, Sanitation Code, and with all other applicable Count Ordinances and the laws regulations of the State of Wisconsin. 3 a i '
<br /> PP 9
<br /> ...!/..�' N . ja:Q �'..!!?tik ............................ ............�,. ........... .4� .. .C.? .� . N fl o
<br /> OWNER )please priri CONTRACTOR or SURVEYOR or AGENT m e,
<br /> ADDRESS ADDRESS
<br /> d
<br /> ....� /i///i SS �..,...... ,,/� 1
<br /> ADDRESS ADDRESS ........................................ .......................... iW iDC1 i
<br /> ...........................................................................................
<br /> PHONE PHONE................._......................... ...... ....................1........•
<br /> �'+/.. '.fl �. .......................................
<br /> PLUMB R r WELL DRILLER
<br /> .� ....3... .. 1.0...11?4%�1�.. !- ............................................................................................ o
<br /> ADDRESS ADDRESS
<br /> m L7
<br /> PHONE PHONE
<br /> DESCRIPTION 4. Sanitary Facilities: P o ° N
<br /> 1. Work: 2. New Building Details No. Bathrooms I...�...� :`
<br /> New Building h,. Type of Construction: No. Bedrooms L..Z. :v a0
<br /> Addition ,,,.. ., ......,,,, Septic Tank Size Gals. ,,''}}�77�, 0..
<br /> Sanitary ,,.. Size .... ft. x ft, "f"�4'•
<br /> PillingtGrading ........ Height..... ..... Stories ...... . ...... 4a. Absorption. Field Site:
<br /> Moving .......... SoilTYPe ..................s!
<br /> .'. .... . . ....... � ( o
<br /> .......... .q..... 0
<br /> Priv ... 3. Use (describe exactly, 1 famil Pere r
<br /> Mobile Home ... . . . Per . Rate ....................� ......
<br /> Well ome, garage, motel, eta) Privy
<br /> r v Well
<br /> Subdivision ,,,,,,,, Seepage Trench ......... ;"'•••`��� [
<br /> Camping Unit .. .. g........................................ y II......... r .
<br /> ........... Seepage Bed /fJ 2,3.. l sJ
<br /> ------------------------ .___--_ ----_--.----_ —_—.—_- --_ _—.___ -ir___
<br /> Location of proposed structures and existing structures, well sewage systems, roads etc_, should be sk tched In Fq. A. Inc ude road •�1{—p e
<br /> setback, side and back yard dimension and location and setback from all bodies of water. I1 propa ty is locattd at a highwainter- t CL
<br /> section, show the Intersecting highL ways and the setbacks required along them and at the intersection. CLEARLY I ABEEXITING C
<br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. C
<br /> o
<br /> ........... .... ft. x ............ . ft. — r3Q.'.S ����.. s ft. ..........................e C ...RO. T�. . ........., !4
<br /> q.
<br /> . Lot ize: Fig. A. 6. Location:
<br /> N O
<br /> 0
<br /> O
<br /> �t J
<br /> S
<br /> V{vI O
<br /> V, O
<br /> C-(7
<br /> rzIIN
<br /> M on r y m Z
<br /> Z ON. m D _
<br /> O n
<br /> � � � �' S fJfo 70
<br /> k NT l7iC�Cexv�1 U �--� '� - A p
<br /> ................................................ ........ .............................. .. ... -
<br /> Signature of Owner or A�eynt �/Date
<br /> Remarks ... ..... ,...... .. !-4......... -MO
<br /> to
<br /> �n� '...GLI. „rr .....................................................L.....
<br /> ...
<br /> ...............................l�........f.../.......©.................._.................................. ................ ...............................................,I......
<br /> Inspection Date . ..�`..... ...............Z�. .LCL I....., xnm
<br /> .. . ..... . . . . ......... ......
<br /> onin9
<br /> Administrator S $ SSS $ y
<br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facibtwc
<br /> before construction can begin. In the case of sewerage disposal systems, if copy of the percolationtest 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 AIII(I-
<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 nor be made without approval of the Zoning Administrator .
<br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED.
<br />
|