Laserfiche WebLink
Burna It County Office of Zoning Administra or �' c <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and 4 <br /> 3 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of he <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws nd 3 <br /> regulationsof the Stateof Wisconsi n. » g <br /> .......... .Y`.WPA ..G <br /> ......... .4 <br /> ............ . . . . <br /> OWNER I__pfflee--x print) j� CONTRACTOR or SURVEYOR or AGENT i <br /> ....... ,T'!4,:.y 1.7.4..X....$...... <br /> ............................................................ ..... <br /> AD ESS I� � ,) ADDRESS <br /> .......... W.'1........................... . .................................................................................... ..... <br /> ..... ........ . ..0 ...I......... ADDRESS C1; <br /> ADD�SS <br /> rvr�r.....3........j'............................................... ........... .... ' <br /> ........................................................................... . <br /> PHONE (� PHONE 1 <br /> PLUMBER WELL DRILLER -� <br /> O <br /> ......................................................................i.................... ..................................................................................... ...... _. <br /> ADDRESS ADDRESS n 0 ^ <br /> . . . ................................................................................... ... ..........................................Y................................ ......t O » <br /> PHONE PHON......E 0 H r C <br /> DESCRIPTION 4. Sanitar Facilities: / ° o » P <br /> 1. Work: 2. New Building Details No. Bathrooms Z 3CD o ' <br /> New Building Type of Construction: No. Bedrooms .... ;.� <br /> Addition .................................................... Septic Tank Size Gals. ... (}J <br /> Sanitary "' """ ' <br /> .., ...... Size .t........... ft. x Stories <br /> ........ ft: 4a. Absorption Field Site: <br /> Filling/Grading .......... Height............. Stories ............. . <br /> lvlovin yr .......... Area ........................................... Soil Type ............................... ...... r <br /> Mobile Home Slope ............................ ...... . <br /> ......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate .......................... . ...... <br /> i <br /> � � E <br /> Well .......... home,garage,motel, etc.) Dry Well m <br /> Subdivision .......... ..... . .......................................... Seepage Trench ... ...... o 0� <br /> .. <br /> Camping Unit Privy ... ...... <br /> .......... ............................................... .... <br /> W <br /> Seepage Bed .. ...... <br /> kj <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fi . A. :ice C fi�,1m,1 <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is local id at <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersect on. So <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> ______________________________ __—____________________ _ <br /> rr `� Lot Size: Fig. A. 6. Location: (j <br /> ly/ ...���..... ft. x ..........4/ ft. — ...�o... .�?.0........... sq.ft. .... . Y.:I:L..S r'e...."5: �:^.f.. ..R. .. ... <br /> N O <br /> 01 <br /> J <br /> 2q ' <br /> I r, <br /> — b LA + - <br /> e V\: <br /> G I 0 <br /> to <br /> N <br /> vt 1 ' > .•� Q� a rn v rn r 00 S S M <br /> —m. waw 0. 0. ELEy <br /> r N 3 <br /> S;c '< c: 0 m 5 <br /> Z—o ! D -i <br /> p 9Sf t h m <br /> 20 <br /> Signature of Owner or Agent Date - �^ ;�; c <br /> Remarks ........i...�.9.......✓ .!.1. ^...< 7_.......L..S......../:Q...L.r..�T:P. ..... ........ ................................ ....�........ <br /> ...........f.....- !.cz.......1.pt5.. .......Tkir......kci.Nse.......t....<L C.....a. e............. ............... 53 <br /> .U...f... . .f-..... c ,...�- ..... ........7 s � :.c.....�:..5.../�.s � .... .. .. s <br /> Inspection Date ....!.....�..�. ✓..... . t. :............................................................................ .... - o o <br /> �� ' m <br /> Zoning Administrator .l S 8 8880 <br /> NOTE: A preliminary site inspection must be made and site approval grant�on all structures involving sanitary fa ilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this app)cation 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 bee i issued. A permit may be <br /> revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans 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 AND AP ROVED. <br />