Laserfiche WebLink
C C-"Lf"' <br /> Burnett County Office of Zoning Administrator LnT 0 c <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 <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m :V <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> .......... ................ . ... .. ... .... . ............ .... ..... .......... _ <br /> W R please print CONTRACTOR or SURVEYOR or AGENT n <br /> S.T ....... ... . ........... .................................................................... ........... ........... a G� <br /> A RESS ADDRESS <br /> pq — <br /> ? ..P..�ln!. ..lZ ..L �. 5................................. ............................................................................................ 5 �. <br /> AD ESS _ ADDRESS ' <br /> 5a5.- `. !P...�.. ............................... ............................................................................................ <br /> PH NE _ PHONE <br /> �.e.l.�ue.l n. . 1..... 0�. a ................ ................................................................................I........... R, <br /> PLUMBER WELL DRILLER <br /> O <br /> ......................... ............................ ............. <br /> .......................................... ........................................... ........ <br /> ADDRESS ADDRESS m L'1 <br /> � o <br /> .................................. ............ o' <br /> ........................................................................................... ..P.H..ONE..................................... .... <br /> PHONE <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: /////17 ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms .(........ � o <br /> New Building ... Type of Construction: No. Bedrooms .......... <br /> Septic Tank Size Gals. .......... <br /> Addition .......... ........... .. . ...............,../..... .. < <br /> Sanitary .......... Size .. .A .'..ft. x ...C�:.7... ft. """"" ' <br /> FillingtGrading .......... Height Stories ....l......... 4a. Absorption Field Site: '• <br /> Moving .......... Area Soil Type .................................... .o <br /> ........................................... <br /> ..........Mobile Home Slope .......................................... S <br /> Privy .......... 3. Use (describe exactly, 1 -family Perc. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... <br /> Seepage Trench .......... <br /> --Camps <br /> Subdivision <br /> —_ .......... .... ..... .... .....,.................... <br /> Camping Unit Privy .......... UJ <br /> h./j . .L'i-t....................... <br /> Seepage Bed ......... <br /> Location of proposed structures and existing structures well, sewage systems, roads etc.,should be sketched in Fig A. Include road : Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If properly is located at a highway inter- :' LI: <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. b' <br /> ------------------------------------------- <br /> 5. LSize: Fig. A. 6. Location <br /> • ` (y am <br /> .7U.12..... ft. x .. C.Q.. ft. . ............................... sq.ft. .L(J.4.......... ..U. r.l. �j7....fi..' ....Q...... (� 3 E <br /> 14&r" 'jS /C er t''eDc 0014 f <br /> n <br /> N O <br /> 0 <br /> o <br /> /c' 0 <br /> Lu <br /> W :-r M <br /> SC Z <br /> fi t <br /> 0 <br /> c N < N c N <br /> rte-/ m (ha a � � R� G E <br /> _ I O tNit Nw > m � <br /> m <br /> Zo ix o : n 5 <br /> lit o di 0 a m 3 <br /> M <br /> ... . ... . . ...... � ...................................... ye a <br /> C <br /> Si not f Owner or Agent Date pp _ _ — <br /> Remarks ... . r % S C1'GhI[C G b �C'I ! �.1�.......�.h� x O <br /> .,�.R�9.Cr.. ........................................... ...... .T...............-C.................../�..`........ <br /> .�tT.{1............. .t:.1? ..........�.F.........s�. 1�............ .: ..r................. L P.. `F <br /> > .........F... .c>.m. ............ A..1. . ................................. ........................................... <br /> T <br /> m <br /> Inspection Date ....................................... ..... '�........ .�li..........................4.......... e: u. u, o v, o . m <br /> Zoning A mints ator C 8 8 8 8 8 yr <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <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 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 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 />