Laserfiche WebLink
Burnett County Office of Zoning Administrator �' o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMITm 3, <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and '� # 0 <br /> � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements ol the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. _ a <br /> K. � <br /> _ .....5..1.X0 :?.u°-�.>�.p............................... .................................................................................... ....... _ <br /> OWNER (Please print) CONTRACTOR or SURVEYOR or AGENT <br /> AD RESS I ADDRESS m <br /> X30 <br /> .................................................. ....... <br /> ..................................... .. <br /> ... . ................... 'A-bb ....... .................... <br /> ADDRESS ADS <br /> ................................................................................ .PO <br /> HNE..................................................................... <br /> PHONE <br /> .......................................... <br /> .... ...................................................................................... . . . .................................. . ....... `,r <br /> PLUMBER WELL DRILLER (g : •Vfl <br /> ........................................................................................... . . ...... . ....................................................................... ....... . <br /> ADDRESS ADDRESS v .o ' <br /> a. < <br /> . . . ................................................................................... . ................................................................................. ........ <br /> PHONE PHONE Z <br /> DESCRIPTION 4. Sanitary Facilities: P 8J ° <br /> No. Bathrooms v <br /> 1. Work: 2. New Building Details " id o�j <br /> New Building ..X.... Type of Construction. No. Bedrooms <br /> Addition .. .. ....�y,�X/,1,....1.:�.VKYO ...... . Septic Tank Size Gals. <br /> .......... i <br /> Sanitary ...X.... Size ..:a$.... ft. x ...W..... ft. <br /> Filling/GrWing Height.... Ar... Stoes ...../........ 4a. Absorption Field Site:P!t yo,.. ... <br /> Moving .......... Area ................../ .......... Soil Type ......... � .......�.�4...: o <br /> Mobile Home .......... Slope ............... v r-- <br /> }iI <br /> I i <br /> Privy .......... 3. Use (describe exactly �1 -family Perc. Rate .................... .... ........ <br /> 'Ttiom�garage, mote ,e .) Dry Well . ........ _ <br /> Well ;1 <br /> .......... motel, Z :a <br /> Subdivision ......... ----- ........... Seepage Trench ...... q <br /> .. <br /> ....................................... Privy n <br /> Camping Unit <br /> Seepage Bed /Kx`�5 iu :`/; <br /> ______________________ __________________________________________ ___ \ .�+ .y t1�, <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in F g. A. ; `� c <br /> FL <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at (� <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the interse tion. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> __________________________________________________________________ ___ <br /> 5. Lot-Size, 9 - C Fig. A. 6. Location: .� - <br /> 1 J �}- � <br /> ft. x ..G!rF1C.:. ft. . ......�......(!:. ..... sq.ft. <br /> o <br /> 0 C' <br /> S <br /> 0 �J i <br /> v 0 <br /> 0 <br /> T <br /> N <br /> Z <br /> O <br /> A <br /> / f t(I (N'� f e / �1 R/'�!i' l _/� � a n' : m 0 m <br /> \\ J u Na . 9 <br /> k c om <br /> 0 <br /> O <br /> C <br /> A <br /> AM d/- 1112A7 m <br /> Signature of Owner or Agent e o <br /> y <br /> Remarks m <br /> ................................................................................................................................................................. ....... . <br /> u <br /> ................................................................................................................................................................................ ....... o <br /> ....................................................................................................... <br /> 1 Ji �' NODN � .+ N M <br /> y ''x'71/'7 �1 q m <br /> Inspection Date ....................................... :i .... ...L......1..\. .1.W... . ..�,... ....... Ir G <n �n <n o o �n m <br /> Zoning Administr or C\ $ tg g S `(A <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary acilities'before construction '. <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this ap Aication before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has b n issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans r specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />