Laserfiche WebLink
Burnett County Office of Zoning Administrator M no o 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 c � <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> ........WLR /A.i!......lF ...SGo..✓/..A.�.................. f <br /> a <br /> d <br /> OWNER (please print) CONTRACTOR or SURVEYOR or, AGENT o. m <br /> ...... ... ............... .... . .... ..... ...... . ...... ..... .. <br /> ADDRESS p ADDRESS :\ <br /> ......+(!.1.4: .. .u.l.?..Y........................................................ <br /> ADDRESS ADDRESS <br /> /1..7.7A!Rj� >A. f... Tfr+e.�... MA-1 <br /> ............................................................................................ <br /> PHONE // PHONE <br /> O �. <br /> PLUMBER WELL DRILLER <br /> ADDRESS ADDRESS � 0 <br /> � o <br /> ........................................................................................... ............................................................................................ o ,» <br /> PHONE PHONE zH <br /> r <br /> DESCRIPTION 4. Sanitary Facilities: ° o ° <br /> 1. Work: 2. New Building Details No. Bathrooms " o ' <br /> New Building Type of Construction: No. Bedrooms .......... I <br /> Addition Septic Tank Size Gals. .......... "' <br /> Sanitary .. - ^ <br /> .......... Size a1.: -... ft. x ..../P7—' ft <br /> Filling/Grading .......... Height.....7..... Stories .....I........ 4a. Absorption Field Site: <br /> Moving ,,.,.,,,., Area ........�..l...................... Soil Type ..................... . .......... �` or <br /> Mobile Home .......... Slope .......................................... r ,* <br /> Perc. Rate ................................... O i <br /> Privy 3. Use (describe exactly, i -family <br /> Well Dry Well .......... CL <br /> ,......... home,garage, motel, etc.) <br /> Subdivision ...,,,,.,, / f' Priv Seepage Trench .......... E <br /> .... .... ......... . ..... <br /> A �1/ l <br /> Camping Unit .......... Y .......... <br /> ................................. .................. <br /> __________________________________________________ Seepage Bed_________ <br /> Co <br /> Location of proposed structures and existing structures, well, sewage systems, roads,etc_ should he sketched in Fig_ A- Include road � Q <br /> setback, side and back yard dimension and location and setback from all bodies of water_ If property is located at a highway Inter- o. <br /> section, show the intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING I < <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. O o' <br /> 0 <br /> 5. Lot Sizer D Fig. A. 6. Location <br /> p S / W cS-s <br /> .�. '.(�..... ft. x .............. ft. — ........ . sq. ft. ...........s �.G...... .............: �......................... V i <br /> � 4 <br /> /T1ir. 'r <br /> 4,6'0UT 100 / " ', 0 <br /> N 'Z�c o <br /> o <br /> Us <br /> as - <br /> 0 <br /> z <br /> 0 <br /> d <br /> G07-r46£ <br /> MVlr v .N 2 <br /> c m <br /> "O 3 N d n N d <br /> (Jl H CG b = m <br /> z o o D -' m <br /> o c n <br /> ' \ <br /> ry ; I'd <br /> ................................................{.Lorv,A.G .............0'-e � ��� p <br /> 0 <br /> Signature of Owner or Agent Date x <br /> Remarks , ��.�r..q <br /> m <br /> ...................................................................................................... ........... ... ;o <br /> O: N m m <br /> N N + W + <br /> Inspection Date ....................................... u, v, o u, o m <br /> III Zoning Admini trator �`� g S 8 0 0 o t/r <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 he 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 />