Laserfiche WebLink
ell^ ( 6);' <br /> Burnett County Office of Zoning Administrator o <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 v, <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_ 3 a i UJ <br /> ��� . ...t. ...RR, ,..N.e <br /> O <br /> ../h....�J..K� . ..............�s- . ./... ....... ..... <br /> OWN (please print) CONTRACTOR or SURVEYOR or AGENT a <br /> / �./.....f3o�C... .�f-F a <br /> ......................... d <br /> ADDRESS ADDRESS m Y <br /> C <br /> P u. ........Lj...t..a..........§ a 9 .......... ............................................................................................ p� <br /> ADDRESSADDRESS .. .../ 3.34........ ..... .... ...................... . .......................................................................................... <br /> PHONE PHONE;L1 <br /> i <br /> PLUMBER WELL DRILLER , <br /> . .. . .............................................................................. . .......................................................................................... <br /> ADDRESS ADDRESS <br /> .. ........................................................................................ .PHONE...............................................................:.......................... o .: <br /> PHONE z H r <br /> DESCRIPTION 4. Sanitary Facilities: 0 <br /> 1. Work: 2. New Building Details No. Bathrooms .......... c <br /> No. Bedrooms a <br /> .......... <br /> New Building .,,....... Type of Construction: Ey 1 T <br /> Addition (�=r¢, .......... Septic Tank Size Gals. .......... <br /> .X..... ...... <br /> t� Y..... ft. ........... <br /> Sanitary .......... Size ..�1.�...... ft. x .. ... . <br /> Filling/Grading : p <br /> .......... Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving Area � ............... Soil Type ........ .... ... ... .......... : -1 o <br /> ..................Slope ................ ...... r <br /> Mobile Home .......... <br /> Fare. Rate ................................... <br /> Privy .......... 3. Use (describe exactly, 1 -family ; <br /> Well Dry Well .......... � <br /> ., home, ara motel, etc.) j . <br /> Seepage Trench <br /> Subdivision .......... .................................................... .......... <br /> Privy .......... <br /> _— re— <br /> Camping Un-t— .......... .................................................... Seepage Bed �' <br /> --- ------------------------------ E <br /> 1 <br /> Location of proposed structures and axis Yang stru c[u res, well, sewage systems, roads, eta, should be sketched in Fig A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If propecy is located at a highway Inter- �- <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING �, o <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> 5. Lot Size: -q tTCIC'S Fig. A. 6. Location: <br /> ................ ft. x .............. ft. — ............................... sq.ft. ............................................................................... V <br /> Q <br /> Cn_ <br /> N C <br /> OCD <br /> J <br /> UJ <br /> O <br /> d� N <br /> DJ <br /> �y� Cj-rt�r Dom-eI/t 113 ' <br /> ao <br /> 1 Q (1 <br /> of, <br /> D cmr v � mm z <br /> N C � 0_ 7 c N <br /> 'ci <br /> \1 \"1 i a toam m a m n <br /> ,2 m n <br /> 0 o o n n a <br /> flKL o = am <br /> a <br /> a n <br /> ........ <br /> Signature of Owner or Agent Date X 7 <br /> T , r <br /> Remarksf` C' �........................ ..(.............................:.. .................................................... , C <br /> yy <br /> Inspection Date ....................................... .Lr1'uw) :..... �GJu-� ......✓ .......... <br /> ..... ... V i 0 0 0 ' o ' r <br /> Zoning Administor7� 0 0 0 o t <br /> NOTE: A preliminary site inspection must be made and 'slte approval granted on all structures involving sanitary fecilitios <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 budd- <br /> ing until a permit has been issued. A Permit may be revoked if misrepresentation of any of the information conveyed hero <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of the Zoning Admnns Lratoi_ <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />