Laserfiche WebLink
Burnett County Office of Zoning Administrator iu 1 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 /> 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. 3 ma � <br /> r <br /> Y..I.N....�: h'01 iQ.sP�✓ .J..l �vi d �i✓a� . S.o ....:..................... H f <br /> ° o <br /> H d <br /> WN (plea e print CONTRACTOR or SURVEYOR or AGENT m ' <br /> e ...f..K. 'a .......... ................ <br /> ............................ <br /> .................................................................ADDRSADgRESS/� ��... Q � ..... ......................................ADDRESSADDRESS <br /> 05 <br /> ........................................................................................... <br /> 3. ..7...— ..33............................................. ° <br /> PHONE PHONE �\ <br /> ........................................................................................... � <br /> PLUMBER .......... <br /> .......................................................................... � V <br /> ........................................................................................... ............................................................................................ <br /> ADDRESS ,pgBq{.f;gr — <br /> m C) <br /> n o <br /> ........................................................................................... <br /> PHONE oma., - N <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: / No. Bathrooms 'O i <br /> `/ 2. New Building Details <br /> New Building ,,...,.,,, NO. Bedrooms ..... ° <br /> 9 Type of Construction: .. a <br /> Addition (q , Septic Tank Size Gals. <br /> Sanitary .......... Size ....art- ft. x .....7.4.. ft. ...• ...• <br /> Filling/Grading . , 4a. Absorption Field Site: `" <br /> . . ...... Height........... . Stories .. ........... P i <br /> Moving .......... Area . . ................ Soil Type .............. i <br /> ............. . r <br /> Mobile Home .......... Slope .............. ...... ................... <br /> Privy Pere. Rate ......... . . <br /> 3. Use (describe exactly, 1 -family • <br /> Well Dr Well <br /> .......... home,gara e, motel, etc. y "• •••• • <br /> Subdivision ......•... �-RR4i�- Seepage Trenc .......... <br /> Camping Unit .......... Privy .......... n <br /> .................................................... d <br /> Seepage Bed .......... G <br /> ----------------------------------------------- --------- t ' i <br /> Location of proposed structures and existing structures,well, sewage systems, roads, etc., should be sketched in Fig. A. Include road � Ccsetback, 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 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> --------------------------------------------------------------------- :lY? <br /> 5. Lot Size: Fig. A. I Lcation <br /> y/ /.� o <br /> . .tD.O... ft. X . � Oft.ft. — ..L.........�.�.....U..... sq. ft. .G.,D.T/...j'.....SJ(.. .r.�-..S.Q.. .✓.....PAI-i'I� <br /> L�kQ p <br /> N <br /> m <br /> i o S o. <br /> r � � <br /> 4. <br /> Z <br /> a . <br /> i <br /> t "+ <br /> D cnm a m Z <br /> A cr < <br /> C' f <br /> Lin <. = m a <br /> D n <br /> o Q <br /> i o <br /> m <br /> a <br /> .`.rr................... ................... ....f}uDat po p <br /> Signature of Owner or ent ter— / Date�"f'�7 <br /> Remarks ..l"0. ..,. .w'f:.a: ,e.....l..U/.1..! .' ....... ..................Jr ` ,..►•'.flY�...�r�. ...��................................... �l : m <br /> Twf�. ��'1 1.:. tidrS' d n/ C>wE..c� `D <br /> ................ . .......... ............ a ......... . !v°��.........5 ............... ....... .......:....7......................... os <br /> .�a6r 5 a ccs �. / [[ �, <br /> r........................ ........�........................ . �1..�t,ot....E?2........�.,.d�..tcl O� �p w�,s/.f. �y. �l` <br /> SCL�4 m <br /> Inspection Date.......... ....... . . .... .. . . ........ .. o o o <br /> Zoning Administr or $ $ $ $ $ $ y <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilitlas <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 riot 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 Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />