Laserfiche WebLink
Burnett County Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. o <br /> TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as < — <br /> 9 <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 e <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> MA.R.c.v.s.......Li,....hill..u.F.►.......... ........................................................................ .................. o <br /> n <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> m <br /> FA <br /> ... .......... ..SAII.......a.A.Rt.4.A.y....S.t:.. <br /> ............... <br /> ADDRESS ( r— ADDRESS <br /> ADDRESS <br /> ...................S.-I....irJ....R.UL...,....'.\.M u....(�.A.t..�..lV.. .ADDRESS............................................................................ <br /> &lPil u ...61&1.71.00 ...... . ........................................... ............................. ..... .... <br /> HONEPHONE <br /> ................. ................( 8.6 g..... ............ ....................................... ....... ..................... ......... <br /> PLUMBER WELL DRILLER <br /> O YO <br /> .......... <br /> ........................................................................................... .AD......DRESS...FS'S.................................................................. —. <br /> ADDRESS n o <br /> ............... <br /> ........................................................................................... ............................................................................. o ,» <br /> PHONE PHONE Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> Bathrooms <br /> 1. Work: 2. New Building Details No. Bat <br /> New Building ,,,,,,,,.. Type f Construction: No. Bedrooms L <br /> Septic Tank Size Gals. <br /> Addition k ........ b. ...... y A....... .......... < <br /> Sanitary .......... Size ...... .Q`�. ft. x .....t. ft. .......... . <br /> 4a. Absorption Field Site: ' <br /> Filling/Grading .......... Height .7. tortes ..�........... Soil Type ype .................................... r <br /> Moving .......... Area .............1 .................. <br /> t7 /\ ° <br /> Slope <br /> Mobile Home .......................................... .� o <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Wel( ,......... home,garage, motel, etc.) Dry Well .......... <br /> Subdivision 8_ �- Seepage Trench .......... ? '..�� <br /> .......... .........�-^�^ .. "'1,..... <br /> Privy <br /> Camping Unit .......... ,,,,,, .. G0.W.KS.c"k�l... <br /> /'" Seepage Bed ...... — <br /> Location of proposed structures and existing structures, well,sewage systems, roads, etc., should be sketched In Fig. A. Include road ' e <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> 1"RUCTURLS AND PROPOSED STRUCTURES AND ADDITIONS- E. [ o <br /> ------------------._____—_____-----_--_______--_---_____—_ O <br /> 5. Lot Size: r rr Fig. A. 6. Location: O <br /> .Atsill2.. ft. x _�. J.. ft. — ......� .).k .M... sq. ft. ........... ....-..................................................... n <br /> IN 0 <br /> Sol <br /> G' u 0 <br /> Igo ) <br /> 30 <br /> JL <br /> is 19 r <br /> Z <br /> ay <br /> :n <br /> m <br /> .+ O T. '� D a n1 <br /> Z O O n <br /> o c nm 3 <br /> p m <br /> ` c"^'`^..„ ....................... .............. J o p <br /> Signature of Ownerzor Agent Date <br /> Remarks ... ........... ` /..... !/.....J........................................................... . . . . <br /> . . .................... ..... .... ....... <br /> w <br /> u <br /> .......................................................................................................... ... ....... ... <br /> QE <br /> sem__ w N a N m <br /> �. ... ...s! -- Uu ou <br /> Inspection Date oi. m <br /> Zoning Administrator i o 0 o g g 6 V1 <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitaty tacilitles <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test most be attached to <br /> this application before a permit will be Issued. Do not purchase or Install a septic tank, do any plumping 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 />