Laserfiche WebLink
E,urneft County Office of Zoning Administrator iu 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as <br /> - o )J <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use I c <br /> m <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> Lue, l e c� , .... ..e. ., .......... . ............................................................................. y. . 6U.a........................ .....1.. .......M ,. <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT O. ;C <br /> .ou.��.....3................B.ax... )..8 ............................................................................................ d <br /> ADDRESS ADDRESS = : I i� : n <br /> . .. .d.. ,.. z.;.. ... 1� ......s8 .7.. .......... ...:...................................................... ................ .... �. <br /> ADDRESS ADDRESS : I ; I� <br /> 3.a..7.-.y2... 3.............................................. ............................................................................................ <br /> PHONE PHONE : m <br /> ........................................................................................... ............................................................................................ <br /> a <br /> PLUMBER WELL DRILLER : g <br /> H <br /> ADDRESS 'A"'D"DRESS n o <br /> G h <br /> ........................................................................................... .....O..NE..................................................................................... �Z o : 3 <br /> PHONE PH ; m <br /> DESCRIPTION 4, Sanitary Facilities: ° o ° <br /> 1. Work: No. Bathrooms <br /> 2. New Building Details ""'••"' ` o <br /> New Building .......... Type of Construction: No. Bedrooms .......... iN <br /> Addition „ ,,,,,,,, Septic Tank Size Gals. .......... i <br /> .. .... ............................................ <br /> Sanitary .......... Size .............. ft. x .............. ft. .......... <br /> Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: i <br /> Moving .......... Area ........................................... Soil Type ....................... ............ T' <br /> Mobile Home Slope .......................................... A ,. <br /> .......... <br /> Privy ,,,,,,..,, 3. Use (describe exactly, 1 -family <br /> Pero. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... i <br /> Subdivision Seepage Trench .......... <br /> Camping Unit— Privy .......... <br /> Seepage Bed .......... <br /> ------------------------------------------------------------ Q O rn <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include roadI T 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 a <br /> section, show the Intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING �� 1 k.... <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. x/” o' <br /> ---------------------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> I � � <br /> ................ ft. x .............. ft. — sq.ft. ............................................................................... n i <br /> N <br /> Application for Land Use (6 month period) 0 i o <br /> Camping Permit from MA 1 p 7 to 1110 y 19 8h o <br /> y 0 <br /> I � <br /> N J <br /> T ? V <br /> \Q Z G <br /> urt ✓1 �� 75 / Qf7` �J{M , 6F LAKE <br /> s <br /> Op o <br /> m cc n, <br /> N N d a <br /> C .` N OU <br /> S C <br /> Z Oo m D n <br /> o Z1 n ro <br /> ON <br /> 0 _ <br /> Signature of Owner or Agent Date X : <br /> See pond. ermit 11618 ermits #11225 11847 & 12403 T ' <br /> .................:...P................................t...........................................................—............... J <br /> Remarks ............................I? <br /> n <br /> ............................................................................................................ .. ............. .... <br /> Inspection Date ....................................... u' U o o <br /> v, , , Zoning Ad nist�� 80 0 0 0 0 <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 Adm inistratoi . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />