Laserfiche WebLink
Burnett County Office of Zoning Administrator 3 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 9 o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described Ind »' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws ndCL <br /> » x0 <br /> regulations of the State of Wisconsin. <br /> /A'Z' r r�Y.. ..............5`....s.z..J .............. ...... = + 4 <br /> . <br /> OWNER plasia p �........... 'CONTRACTOR or SI VEYOR or AGENT : � » <br /> OWNER IDlesu Print) <br /> R.. x....f3.7.......................................................... ..................................................................................... ...... a <br /> ADDRESS m rpt <br /> ADDRES� /y . <br /> ADD�ESS .......::::.:( .. .......� /..... .................................................................................... ...... t i7 <br /> J / 6 <br /> ADDRESS ' <br /> .......... ............................................................ .................................................................................... ....... <br /> PHONE <br /> PHONE <br /> l <br /> .......% .s. ........... ....... . rt <br /> Iny ................................................. .................... .................... <br /> WELL DRILLER .� <br /> PLUFIBER O ;a <br /> —• O. .................................................................................. . m <br /> ........................................................................................... ADDRESS <br /> ADDRESS < '^t <br /> ...... ....... <br /> ........ . . <br /> . ........................................................................... vl <br /> PHONE <br /> PHONE <br /> .. ........ <br /> O <br /> � O ; <br /> 4. Sanitary Facilities: <br /> DESCRIPTION i— <br /> No. Bathrooms � c <br /> 1. Work: 2. New Building Details . O-- <br /> Type of nstruction: No. Bedrooms ;•.Y. <br /> New ewlmeg ....x.. r-t,M ._p <br /> Septic Tank Size Gals. <br /> 1 <br /> Addition S V <br /> ......... .; <br /> JO... Size ...2.a.... ft. x ... ..9...., ft. <br /> Sanitary <br /> •• • • 4a. Absorption Field Site: <br /> FIIIIngl Grading .......... Height............. Stories ............... Soil Type ........................... ........ : S <br /> MovingArea ........................................... Slope » i <br /> Mobile Home .......... ................................ ......... v <br /> Perc. Rate ......................... ......... <br /> Privy 3. Use (describe exact) , t -Tamil Dry Well m <br /> home,garage, motel "etc. <br /> Well z 'a <br /> •• �••••�� Seepage Trench •••�� o <br /> Subdivision .......... ...�.. 'M .l L y.... M.E•.••• •-• Privy ... <br /> rivy <br /> Camping Unit .......... ......................................... .......... Seepage Bed /b <br /> X <br /> -- — <br /> ------ — — — — <br /> --- — — — — — <br /> — — ----- --- fl .� i C <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in F ig. A. <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is loc kted at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the interne tion. '('0 o <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. L` <br /> —_ . - <br /> ______-- -- O <br /> 5. Lot Size: Fig. A. 6. Location: � �� <br /> sq.ft. .... .. I..YL7i.............. .......... :� <br /> ft. x .............. ft. — <br /> N 0 <br /> :a <br /> O y I <br /> ' ? <br /> � Ty- <br /> d <br /> A <br /> 0 C� m V <br /> �d <br /> m. m <br /> na y <br /> y G N O m 0 <br /> ONO ' d <br /> M <br /> C O ^ <br /> O J Y <br /> A c C <br /> a - a - <br /> Q... . . ......................... ...................................... <br /> m S <br /> A : R <br /> Signature Owner or Agent Date : <br /> Remarks ...Crl..../(..,.�C. < ......... it a <br /> U' o ......... cit <br /> / o . g <br /> .................................... ................................ <br /> ....................................... <br /> ...... ........ <br /> y. <br /> Inspection Date - f( 8 S 8 8 S i <br /> Pe Z.... "'?L "" """""' ZoninAdministrator <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitai y facilities <br /> construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this pp tibefore cpermit <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 plan i 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 AN APPROVED. <br />