Laserfiche WebLink
61 beg, <br /> Burnett Cqunty Office of Zoning Administrator o 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR'. The undersigned hereby makes application for a Permit for the work described and located as 's h <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. M <br /> 3 <br /> EE <br /> a, <br /> ....�. (plea ... . . ..... ........... ............. ...... ...... ... ......... .... T.. ..... .....(e.ls4 .... ...... ....... ° <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> ..3. .a......- Ta�s1. �. ..e .......��as.:...N. .... C� <br /> ADDRESS <br /> . . ..................................................................... <br /> ADDRESS ADDRESS ;Y.J <br /> ........... <br /> ................................................................................. .......... 1 <br /> PHONE PHONE <br /> 1�.;..�.I.S .......................................... ............................................................ ..... . ....................... <br /> PLUMB WELL DRILLER i�(I <br /> ...... k............ .C.f..9.1.1.2.1..T..t.,.`1............I..... FUw" .p <br /> ADDRESS ADDRESS Ct <br /> .................. 6 g.�3............................................... .................................................................................'........... g [ <br /> PHONE PHONE Z m <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms <br /> T No. Bedrooms :� 00 <br /> New Building Type of Construction: <br /> Addition Septic Tank Size Gals. ..... <br /> .......... ....... ............................................ <br /> Sanitary ... ... Size .............. ft. x .............. ft. <br /> Filling/Grading .......... Height........... Stories ............... 4a. Absorption Field Site: <br /> MovingSoil Type .................................... r <br /> .......... Area ........................................... <br /> 0 <br /> Mobile Home .......... Slope ...............................:........... -� <br /> Privy ..,,...... 3. Use (describe exactly, i -family <br /> well .......... home,garage, motel, etc.) Dry Rate ......................... <br /> Dry Well . <br /> Subdivision Seepage Trench <br /> .................................................... <br /> Camping Unit .......... Privy i <br /> .................................................... Seepage Bed Z . <br /> _----.----------------- —_-----___---_.—___ -----�--- .N <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched In Fig. A. Include road <br /> Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highw�y inter- i a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CI_FARLY LABFL EXISTING Q <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONSN' <br /> 1 o <br /> ---_--- <br /> 5. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq. ft. ............................................................................... <br /> 0 <br /> n <br /> 0 0 <br /> 0 <br /> 0 <br /> p <br /> s <br /> ' T <br /> i t 0 <br /> O <br /> t 7J <br /> m <br /> E <br /> M o1 r ou :i 0 Z <br /> C' < �_ c m <br /> Un y _ C z <br /> p 5 M D n m <br /> / Z O O ¢ T <br /> �o <br /> C1J o <br /> Signature of Owner ` Y ���Date E C <br /> Remarks . ...... . C'L "��/`� . C <br /> .................... ......................................................................................................................... <br /> ea <br /> .......... .................................................................... ................................................................ <br /> ........................................ ...qq...�.....pp...//................. .......................... ... . ................... . ......... .................................. <br /> ... <br /> Inspection Date . '.`aZ.L..�..!l..CG?..,... .... ....... .. ..... ...... .. ` U o' u, o � rrr <br /> r <br /> Zoning inistrator $ o 0 0 0 o U. <br /> NOTE: A preliminary site inspection must be ma e and site approval granted on all structures involving sanitary fa thts <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be atta her] 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 revoker) 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 Administratoi. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />