Laserfiche WebLink
• �/'/Com/ <br /> Burnstt County Office of Zoning Administrator �' c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3• <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '� # <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ,� c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> re ulatwri,of the State of Wisconsin. " <br /> L�€NNS s..... uNsk,............................................ ...SL/F......... p , <br /> .............................................................. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT iu <br /> ......cp.v .................. ..0�4. .....5.{Lf+/ .....�....rss........................................... <br /> A DRESS ADDRESS <br /> uiNJ✓r��b /yf(UN rfs,37 UfU/�C tJ/ (s <br /> .................................................. ................. .. +'.........................�I1.................................................. °s <br /> AD/DRESS ADDRESS 1 <br /> PHONE PHONE <br /> ............... <br /> ..................................................................... :CIq <br /> PLUMBER WELL DRILLER <br /> ......... ................................................................................. ............................................................................................ O <br /> ADDRESS ADDRESS C <br /> ................................................... <br /> 0 < <br /> ........................................................................................... .P..H..ON....E................................ Z = .: <br /> PHONE r— Ys <br /> DESCRIPTION 4. Sanitary Facilities: 3 0 c 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .... LQ) o <br /> .. <br /> Nev, No. Bedrooms <br /> Building � Type of Construction: <br /> .......... <br /> Addition ,(r(f,(7p�„`r{7M••, ...• ... . Septic Tank Size Gals. ... ... C1 ;a. <br /> .. <br /> .......... ...... .......... i <br /> Sanitary .......... Size ... ft. x .3U........ ft. <br /> Filling/Grading .......... 2 4a. Absorption Field Site: <br /> .......... Height............. Stories ............... - <br /> Moving .......... Area ......l..S...OO ......... ............ Soil Type .................................... r i <br /> .. <br /> Mobile HomeSlope .......................................... v :7 0 <br /> .......... Perc. Rate ............................. i <br /> Privy .......... 3. Use (describe exact) '1 -famil 0 <br /> Dr �C <br /> Well .......... home,garage,motel, etc.) y Well .......... m •'. <br /> SubdivisionSeepage Trench .......... o <br /> Camping Unit .......... .................................................... Privy t 1 <br /> Seepage Bed � � FAN <br /> , <br /> _______ ___________________ ___—___—_-------_____-- •y t� <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. ' <br /> Include road setback,side and backyard dimension and location and setback from all bodies of water. If property is located at r- YJ _ <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. o <br /> _________________________________________________________ <br /> 5. Lot Size: Fig. A. 6. Location: i <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> t <br /> 1 <br /> 0 <br /> O <br /> 0 <br /> O <br /> I v <br /> Z <br /> 6”` o <br /> Idl"/Vt <br /> `I(Y o c v. wd0 C C <br /> Cnv < = n — <br /> � Uc.i <br /> Zoy. . � � orom <br /> o a <br /> N= Mo . <br /> o 9 <br /> 0 2 m <br /> 0 <br /> o <br /> gnature o wner or Agent D e $ <br /> Remar s ..... <br /> o : g <br /> .............................................................................................................. .... ............... .. .. .... <br /> 0 <br /> InspectionDate ....................................... i ��...�........................... v o o v <br /> Zoning Administrator 2ik5 $ o <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <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 or 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 APPROVED. <br />